Abstract
In patients with liver failure, the accumulation of lipophilic, albumin-bound toxins occurs which cannot be eliminated by standard hemodialysis and hemofiltration techniques. For this purpose (artificial and bioartificial) liver support systems were developed. Extracorporeal systems for artificial liver support include: Molecular adsorbents recirculating system (MARS) Single-pass albumin dialysis (SPAD) Fractionated plasma separation and adsorption (Prometheus) Selective plasma exchange therapy (SEPET) Extracorporeal systems for bioartificial liver support include: Extracorporeal liver perfusion (ECLP) HepatAssist Extracorporeal liver-assist device (ELAD) Modular extracorporeal liver support system (MELS) Bioartificial liver of the Academisch Medisch Centrum (AMC-BAL) The MARS, SPAD, and Prometheus systems are available for clinical use and are mostly employed either for bridging the patient to transplant or else for bridging to recovery of liver function. Positive data exist regarding biochemical efficacy and clinical improvement of certain end points such as hepatic encephalopathy, but adequately powered clinical trials evaluating survival rates are at present lacking.
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