Abstract
Acute liver failure (ALF) is a potentially life-threatening condition. Liver support therapies can be applied as a bridging-to-transplantation or bridging-to-recovery; however, results of clinical trials are controversial. Our aim was to compare liver support systems in acute and hyperacute liver failure with network meta-analysis. After systematic search, randomized controlled trials (RCT) comparing liver support therapies in adults with acute or hyperacute liver failure were included. In-hospital mortality was the primary outcome, the secondary outcomes were hepatic encephalopathy and mortality-by-aetiology. A Bayesian-method was used to perform network meta-analysis and calculate surface under the cumulative ranking curve (SUCRA) values to rank interventions. Eleven RCTs were included. BioLogic-DT and molecular adsorbent recirculating system (MARS) resulted in the lowest mortality (SUCRAs: 76% and 73%, respectively). In non-paracetamol-poisoned patients, BioLogic-DT, charcoal hemoperfusion and MARS may be equally efficient regarding mortality (SUCRAs: 53%, 52% and 52%, respectively). Considering hepatic encephalopathy, extracorporeal liver assist device (ELAD) may be the most effective option (SUCRA: 78%). However, in pairwise meta-analysis, there were no statistically significant differences between the interventions in the outcomes. In conclusion, MARS therapy seems to be the best available option in reducing mortality. Further research is needed on currently available and new therapeutic modalities. (CRD42020160133).
Highlights
Acute liver failure (ALF) is a potentially life-threatening condition
Considering the effectiveness of these therapies the results of clinical trials are controversial, currently they are not recommended by thy European Association for the Study of the Liver (EASL) Clinical Practical Guidelines or the American Association for the Study of Liver Diseases (AASLD) Practice Guidelines outside of clinical trials in acute or hyperacute liver failure[12,13]
All studies included in the quantitative synthesis are parallel randomized controlled trials comparing liver support systems to standard medical therapy (SMT), published between 1973 and 2016, including 479 patients
Summary
Acute liver failure (ALF) is a potentially life-threatening condition. Liver support therapies can be applied as a bridging-to-transplantation or bridging-to-recovery; results of clinical trials are controversial. After systematic search, randomized controlled trials (RCT) comparing liver support therapies in adults with acute or hyperacute liver failure were included. HD Hemodialysis HE Hepatic encephalopathy HELLP-syndrome Haemolysis, elevated liver enzymes, low platelet count HVPE High-volume plasma exchange IL-6 Interleukin 6 max Maximum MARS Molecular adsorbent recirculating system PICO P: patients I: intervention C: comparison O: outcome PNF Primary nonfunction following liver transplantation PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses RCT Randomized controlled trials RoB2 Cochrane risk-of-bias tool for randomised trials RR Risk ratio SD Standard deviation SHF Subfulminant hepatic failure SMT Standard medical therapy SUCRA Surface under the cumulative ranking curves TNF α Tumor necrosis factor alpha TRALI Transfusion-related acute lung injury UK United Kingdom USA United States of America. Considering the effectiveness of these therapies the results of clinical trials are controversial, currently they are not recommended by thy European Association for the Study of the Liver (EASL) Clinical Practical Guidelines or the American Association for the Study of Liver Diseases (AASLD) Practice Guidelines outside of clinical trials in acute or hyperacute liver failure[12,13]
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