Liver assistive devices in acute liver failure: Current use and future directions.

Best Pract Res Clin Gastroenterol

Department of Critical Care Medicine, University of Alberta, Edmonton, Canada; Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Canada. Electronic address:

Published: December 2024

AI Article Synopsis

  • * The only certain treatment for ALF is liver transplantation (LT); however, some patients, especially those with acetaminophen-related liver failure, might recover with medical support instead of needing LT.
  • * Extracorporeal liver support (ECLS) is a growing area of interest in treating ALF, aiming to help the liver by removing toxins and promoting regeneration, with two main types: artificial ECLS (like dialysis methods) and bioartificial ECLS (which uses live hepat

Article Abstract

Acute liver failure (ALF) is a rare syndrome where rapid deterioration of liver function occurs after an acute insult in a patient without prior chronic liver disease and leads to jaundice, hepatic encephalopathy (HE), and oftentimes multiorgan failure (MOF). At this time, the only definitive treatment for ALF is LT but some patients, particularly APAP-induced ALF patients, may have ongoing regenerative capacity of the liver and may not require LT with ongoing supportive management. As a result, extracorporeal liver support (ECLS) has been a topic of interest both as a bridge to LT and as a bridge to spontaneous recovery and aims to remove damaging toxins that further aggravate liver failure, stimulate regeneration of the liver, and improve pathophysiologic consequences of liver failure. There are currently two categories of ECLS (artificial and bioartificial). Artificial ECLS does not incorporate active hepatocytes and are based on the principles of filtration and adsorption and includes renal replacement therapy (RRT), plasma adsorption including plasma exchange and Prometheus (Fractionated Plasma Separation and Adsorption), and albumin dialysis including MARS (Molecular Adsorbent Recirculating System) and SPAD (Single Pass Albumin Dialysis). Bioartificial ECLS incorporates active hepatocytes (human or porcine in origin) to improve liver detoxification capacity and to support hepatic synthetic function and includes ELAD (Extracorporeal Liver Assist Device) and HepatAssist.

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http://dx.doi.org/10.1016/j.bpg.2024.101964DOI Listing

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Article Synopsis
  • * The only certain treatment for ALF is liver transplantation (LT); however, some patients, especially those with acetaminophen-related liver failure, might recover with medical support instead of needing LT.
  • * Extracorporeal liver support (ECLS) is a growing area of interest in treating ALF, aiming to help the liver by removing toxins and promoting regeneration, with two main types: artificial ECLS (like dialysis methods) and bioartificial ECLS (which uses live hepat
View Article and Find Full Text PDF

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