Abstract
The realization of a support device able to effectively replace liver function in
patients with hepatic failure has thus far been an elusive goal. The complexity of
liver metabolic, synthetic, detoxifying, and excretory functions make artificial hepatic
support extremely challenging. Currently, no specific treatment is available to reverse
acute or acute-on-chronic liver failure, and morbidity and mortality of these syndromes
are still high. Present management strategies are supportive, while waiting for spontaneous
liver regeneration or liver transplant. Because of the scarcity of donor organs, liver
support strategies are needed for patients with inadequate liver function until an
appropriate organ becomes available for transplantation or until their liver recovers
from injury. Currently available liver support systems comprise nonbiological systems
(e.g., hemodiafiltration, albumin dialysis, and plasma exchange) and bioartificial
systems utilizing viable liver cells. The role for these novel systems and their impact
on survival or other clinically important outcomes are controversial. Development
and use of bioartificial systems are limited by the inherent cost.
Keywords
liver failure - extracorporeal liver support - albumin dialysis - bioartificial liver
