Abstract
Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) are life-threatening
illnesses requiring intensive care admission and potentially liver transplantation.
Artificial extracorporeal liver support (ECLS) systems remove water-soluble and albumin-bound
toxins to maintain normal serum chemistry, prevent further hepatic/organ system damage,
and create an environment for potential hepatic regeneration/recovery (ALF) or bridge
to liver transplantation (ALF and ACLF). Use of artificial ECLS has been studied in
both ALF and ACLF. Artificial ECLS systems have been found to be safe and have demonstrated
the following benefits: improvement of biochemistries, hemodynamic status, and hepatic
encephalopathy. Despite this, only one prospective randomized controlled trial examining
the use of high-volume plasma exchange has demonstrated improvement in transplant-free
survival. Bioartificial (cell-based) ECLS systems build on the technology of artificial
systems, incorporating living hepatocytes in a bioactive platform to further mimic
endogenous hepatic detoxification and synthetic functions. Currently, no bioartificial
system has been found to confer a mortality benefit; however, these platforms offer
the greatest potential for future development.
Keywords
extracorporeal liver support - albumin dialysis - acute liver failure - acute-on-chronic
liver failure - extracorporeal liver-assist device - liver transplantation
