Artificial Liver Treatment, When and Which One?

Abstract

Patients awaiting liver transplantation often are in critical condition with multi-organ failure accompanying the underlying liver disease. Stabilization and safe bridging of the patient to transplantation is a major indication for liver support methods. Various extracorporeal technologies have been tested clinically since the late 1950s. Currently, methods are divided into artificial, or nonbiological, systems based mainly on filtration and adsorption techniques and biological methods employing liver cells, typically of human, sometimes of animal origin. Examples of currently used liver support methods are the molecular adsorbent recirculating system (MARS) as an artificial system and the extracorporeal liver assist device (ELAD) as a biological liver-cell bioreactor. However, a considerable number of other approaches have been studied before or are currently under investigation. As of today, the best clinical experience exists for the MARS system.Liver support treatment should be considered early in the course of liver failure. Stabilization of various organ functions including circulatory, hepatic, and renal function, improvement of hepatic encephalopathy, and reduction of elevated intracranial pressure were observed in clinical studies. Modern extracorporeal liver support methods are safe to perform and a valuable addition to the therapeutic armamentarium of liver failure care.