title: Current Evidence for Extracorporeal Liver Support Systems in Acute Liver Failure and Acute-on-Chronic Liver Failure.
abstract: Artificial (nonbiological) extracorporeal liver support devices aim to remove albumin-bound and water-soluble toxins to restore and preserve hepatic function and mitigate or limit the progression of multiorgan failure while hepatic recovery or liver transplant occurs. The following beneficial effects have been documented: improvement of jaundice, amelioration of hemodynamic instability, reduction of portal hypertension, and improvement of hepatic encephalopathy. The only randomized prospective multicenter controlled trial to show an improvement in transplant-free survival was for high-volume plasmapheresis. Biological (cell-based) extracorporeal liver support systems aim to support the failing liver through detoxification and synthetic function and warrant further study for safety and benefit.
authors.affiliation: Division of Hepatology, University of Alberta, Edmonton, Alberta, Canada; Division of Critical Care Medicine, University of Alberta, 1-40 Zeidler Ledcor Building, Edmonton, Alberta T6G-2X8, Canada. Electronic address: dean.karvellas@ualberta.ca.
authors.forename: Constantine J
authors.initials: CJ
authors.lastname: Karvellas
authors.affiliation: Division of Hepatology, Emory University, Atlanta, GA, USA; Division of Critical Care Medicine, Emory University, Atlanta, GA, USA.
authors.forename: Ram M
authors.initials: RM
authors.lastname: Subramanian
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000628:therapy*; D000327:Adsorption; D003956:Dialysis / Q000009:adverse effects / Q000379:methods; D005112:Extracorporeal Circulation / Q000009:adverse effects; D006801:Humans; D017114:Liver Failure, Acute / Q000628:therapy*; D019164:Liver, Artificial / Q000009:adverse effects; D010956:Plasmapheresis
keywords: Acute liver failure; Acute-on-chronic liver failure; Albumin dialysis; Extracorporeal liver assist device; Extracorporeal liver support; Liver transplantation