Extracorporeal Liver Support

Abstract

Mortality of patients with liver failure remains unacceptably high. As the liver has an enormous potential to regenerate, extracorporeal liver support devices may allow patients with liver failure to be bridged to recovery. Alternatively, liver assist may allow patients with advanced liver disease to be managed until a suitable organ for transplant is available. Current approaches to liver support include the use of biological devices that contain hepatocytes and those that function as detoxification devices, and artificial liver support systems. This review describes the current state of the art and existing data on the use of these devices to treat patients with liver failure.

Prometheus therapy for the treatment of acute liver failure in patients after cardiac surgery

“…Successive passage through the two absorbers containing activated carbon and ion exchange resin provides removal of hydrophobic molecules bound by albumin followed by the recirculation of purified albumin solution as a dialysis fluid. MARS therapy and SPAD provide similar clearance of water soluble and hydrophobic substances [ 6 ].…”

A new horizon for liver support in acute liver failure

“…In the study by Glorioso et al, it is the functional biomass rather than sorbent capacity that appears to be the key element for an effective therapy. That this study uses primary cells rather than cultured cell lines may also prove to be significant in the future development of bioartificial systems due to concerns over the amount of metabolic function retained by transformed cells (8). Neither study indicates specifically which toxins are targeted and removed by their extracorporeal devices, but instead show a subsequent reduction in inflammatory markers such as cytokines.…”

“…The capacity of a device for removal of toxins has always been a key consideration in the concept and design of previous systems. For those based on adsorbent columns, the question of saturation of the materials and hence the effective treatment times have been raised repeatedly (8). Although the system reported by Zhou et al utilizes a sorbent component to the system, its novel combination with plasma exchange appears to offer improved functionality and capacity to remove toxic metabolites.…”

Bio-Pick, Place, and Perfuse: A New Instrument for Three-Dimensional Tissue Engineering

“…They are largely split into artificial methods, based on modified renal hemodialysis, and bio-artificial methods, which utilize bioreactors with hepatocytes in order to provide a more in vivo method of serum filtration. However, success with these devices has been limited, mostly evidenced in acute fulminant liver failure from acetaminophen overdose as opposed to the chronic liver failure as seen in cirrhosis (14,15).…”