Review article: non‐biological liver support in liver failure

Abstract

SUMMARYLiver failure, whether acute or acute-on-chronic, remains an important cause of morbidity and mortality. The lack of liver detoxification, metabolic and regulatory functions of the liver leads to life-threatening complications, such as renal failure, altered immune response, hepatic coma and systemic haemodynamic dysfunction, eventually culminating in multiorgan failure.Current medical therapy involves the management of the precipitating event and treatment of complications until the liver eventually recovers, leaving us with no other treatment options than transplantation if these attempts fail. However, the shortage in cadaveric organs and other transplant-related problems, have prompted the need for alternative methods to provide liver support.As liver failure is often potentially reversible, considerable effort has been invested in the development of liver support systems. Currently, most of the experience is available for non-biological support systems. They represent the focus of this review, which aims to define the goals of liver support, to describe the design of the different existing devices and to analyse the available data to determine their current status in the management of patients with liver failure.

Major Coagulation Disturbances During Fractionated Plasma Separation and Adsorption

“…Besides FPSA, other nonbiological techniques are currently in use to treat liver failure patients, such as the MARS (9). During MARS treatment, albumin bound solutes are dialyzed across an albumin-impregnated polysulphone membrane with a pore size of 50 kD.…”

“…Newer techniques, such as the molecular adsorbents recycling system (MARS) (6) and fractionated plasma separation and adsorption (FPSA) (7), avoid direct contact of blood cells with the adsorbent materials used. These techniques are currently used to bridge patients during fulminant liver failure, either to functional recovery or to liver transplantation (8,9). Results of several large randomized multi-center trials are eagerly awaited.…”

Increase of Ceramide in the Liver and Plasma after Carbon Tetrachloride Intoxication in the Rat

“…In fulminant hepatic failure, toxic substances and cytokines released into the circulation are assumed to cause encephalopathy and renal dysfunction ( 7 ). For the development of effective artificial liver support, it is essential to characterize the cytotoxins and metabolic changes of the liver following intoxication with this chemical.…”

Development of a Multifunctional Detoxifying Unit for Liver Failure Patients

“…These clinical manifestations are presumed to result from abnormal accumulation of hepatic toxins due to substantial decreases in the detoxifying capacity of the liver [1]. …”