Artificial Liver Support: Current Status

Abstract

Orthotopic liver transplantation emerged during the 1980s and has become a standard approved therapeutic lifesaving procedure for the treatment of patients with end-stage liver disease. Patient and grafts have achieved 1 and 10-year survival rates of 85 % and 70 %, respectively []. Despite great improvements in the field of transplantation, mortality in patients developing hepatic failure remains very high. Ten to 20 % of the patients are dying awaiting liver transplantation mainly due to scarcity of organ donors. In recent years, there has been considerable interest in replacement of the liver by extracorporeal systems that may provide a bridge until spontaneous recovery of the liver or until an appropriate donor is available. Many biological and non-biological liver support therapies, based essentially on detoxification of the patient’s blood, have been developed. During the last decade, some of these have reached the phase of human application and are currently undergoing clinical trials. The results seem to be encouraging in some groups of patients with liver disease. In one meta-analysis mixing artificial (5 types of devices) and bioartificial liver support systems (2 types of devices) and including 483 patients, no significant effect on mortality compared with standard therapy was observed []. But in a subgroup analysis, support systems significantly decreased mortality in patients with acute-on-chronic liver failure (33 %, RR: 0.67; 95 %, CI 0.51–0.90) but not in patients with acute liver failure [].