Artificial Liver Support System in China: A Review Over the Last 30 Years

Abstract

Severe viral hepatitis with high mortality is the most common cause of liver failure in China. Treatment of severe viral hepatitis by hemoperfusion was initially adopted in the late 1970s and early 1980s. Following 10 years of development in China, a plasma exchange (PE)-centered artificial liver support system (ALSS), principally dependent on PE technology was developed. Based on the condition and symptoms of each patient, PE was given alone, or combined with hemodialysis, hemofiltration, hemodiafiltration, hemoperfusion, or plasma perfusion. In the late 1990s, training courses for ALSS were developed, and ALSS began to be carried out across China. Guidelines for artificial liver therapy were formulated and published by the Artificial Liver and Liver Failure Group of the Chinese Society of Infection. In recent years, new methods have been attempted, including small pore-size plasma separators, a molecular adsorbent-based recirculating system (MARS), and a continuous albumin purification system (CAPS). According to a retrospective analysis published in 2004, ALSS therapy significantly (P < 0.001) improved the survival rate of patients with severe hepatitis compared with patients who received only medicines (43.4%, 157/362 vs. 15.4%, 55/358 in chronic patients and 78.9%, 30/38 vs. 11.9%, 5/42 in acute and subacute patients). Furthermore, ALSS has also proved valuable as a bridge to liver transplantation in the treatment of patients with end-stage severe hepatitis in China. More recently, ALSS has been used in the treatment of drug-induced liver failure, acute fatty liver during pregnancy, and other difficult-to-treat disorders in China.

Artificial Liver Support System Combined with Liver Transplantation in the Treatment of Patients with Acute-on-Chronic Liver Failure

“…Our previous study has demonstrated that ALSS can efficiently decrease the mortality of patients with severe hepatitis of early and middle stages [3]. However, for patients with ACLF, since hepatocytes undergo massive denaturation, necrosis and dysfunction, it is difficult to completely reverse the clinical course of the disease with routine medical management and even combined with ALSS.…”

Downgrading MELD Improves the Outcomes after Liver Transplantation in Patients with Acute-on-Chronic Hepatitis B Liver Failure

“…Artificial liver support system (ALSS) has been proved to be an effective way to improve liver function and thus serve as a bridge to LT [10]. After such treatment, total bilirubin, international normalized ratio, encephalopathy, and serum creatinine can be remarkably improved and thus MELD score was reduced [11].…”

Combined use of non-biological artificial liver treatments for patients with acute liver failure complicated by multiple organ dysfunction syndrome

“…A significant improvement was observed in the World J Emerg Med, Vol 5, No 3, 2014 survival rate compared to another study. [7] In our study, the survival rate of patients with nonvirus-caused liver failure was 70%, but the survival rate of patients with virus-caused liver failure was 36.4%. The finding suggested that the combined use of nonbiological artificial liver technology plays a significant role in improving the clinical outcomes.…”

“…The survival rate was 42.5% for MODS patients with ALF after treatment with plasma exchange and CVVHDF. [7] In our study, the liver function score was≥IV according to MODS score, and PTA was less than 30%. All patients were in the stage of advanced liver failure according to liver failure treatment guidelines.…”