Systematic review of artificial liver support systems: Current clinical challenges

Abstract

Background: Artificial liver systems are used to bridge between transplantation or to allow a patient's own liver to recover. They are mainly used in patients with acute liver failure (ALF) and acute on chronic liver failure (ACLF). Two examples include molecular adsorbent recirculating system (MARS) and single pass albumin dialysis (SPAD). The main aim of this study is to compare papers that have used MARS and SPAD to show which device is more efficient and a safer treatment. Material & Methods: A literature search was conducted using online libraries including; PubMed, Cochraine and EMBASE. Human publications after the year 2000 that were randomised control trials or comparative studies were included. A systematic review was completed and a comparison of the biochemical values was examined. There was also a comparison of the outcomes and any adverse effects that occurred. Result: 89 patients with ALF or ACLF were involved in this review, including 56 males and 33 females. Results showed that there was an average reduction in bilirubin (-68μmol/L in MARS and -59 μmol/L in SPAD), creatinine (-24 μmol/L in MARS and -2 μmol/L in SPAD), urea (-0.9mmol/L in MARS and -0/1 mmol/L in SPAD)and GGT (-0.26μmol/L.s in MARS and -0/46 μmol/L.s in SPAD) in both SPAD and MARS. However; there was no significant difference between the changes in the two systems. Conclusion: This systematic review proved that both MARS and SPAD are efficient at treating ALF and ACLF. However, there is no difference between efficiency of MARS and SPAD.There is a need for more large randomised control trials. Evaluating cost and patient preference would also help to differentiate the systems.