Extracorporeal artificial liver support in hepatic failure: pathfinder, bridge to recovery or dead end street?

Authors


Acute and acute-on-chronic liver failure are disease entities with high morbidity and mortality. Extracorporeal liver support systems were designed to bridge patients to liver transplantation or to support recovery of the severely disordered liver (1).

Two systems are currently under investigation: bio-artificial and artificial devices. Bio-artificial systems use hepatocytes as bioreactor to replace the function of the native liver during hepatic injury. On the other hand, artificial devices like molecular adsorbent recirculation system (MARS), single pass albumin dialysis and fractionated plasma separation and adsorption (Prometheus) use albumin as scavenging molecules.

A prospective randomized controlled multicentric study demonstrated improvement of hepatic encephalopathy using MARS in comparison to standard medical treatment (2). Recently, the first larger randomized controlled studies using MARS (4, 3) and Prometheus (5) were presented. Preliminary results in patients with acute-on-chronic liver failure were sobering (5, 4) and initiated a controversial discussion concerning clinical relevance of artificial liver support devices. However, the story does not seem to be over yet: preliminary results of MARS in acute liver failure were promising although the complete report of the study has to be awaited (3). Currently available data illustrate increasing need for new prospective randomized controlled studies to clarify indications and clinical impact of extracorporeal artificial liver support devices.

The 8th International Society for Apharesis congress in Vienna, Austria in 2011 focuses on extracorporeal artificial liver support systems in clinical practice. International experts in the field were invited to share their experiences and knowledge. We are proud to present a collection of concise reviews that evaluate the currently available therapeutic impact of extracorporeal artificial liver support systems in the field of acute, acute-on-chronic liver failure and related diseases like hepatorenal syndrome and pruritus. Last but not least, we want to thank all participating authors for their excellent contributions.

Acknowledgement

Conflicts of interest: the authors have no conflicts of interest.

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