Effects of Extracorporeal Liver Support Systems in Liver Failure

A mortality rate in patients with liver failure remains high. Currently the main causes for liver failure are viral hepatitis and alcoholic liver disease. As a result of liver detoxification malfunction a number of complications, including hepatic encephalopathy, hepatorenal syndrome, circulatory disorders develop. Different types of extracorporeal therapies and their combination are used to treat the liver failure for a long time. Figuratively, extracorporeal liver support systems can be divided into two groups: biological and non-biological. Biological methods are based on the use of isolated hepatocytes suspension. Non-biological methods include dialysis, hemofiltration, plasma exchange, hemosorption, Molecular Adsorbent Recirculating System (MARS) and fractionated plasma separation and adsorption (FPSA or Prometheus). Modern technologies allowed to combine liver support systems into a whole and to create an additional method of liver failure treatment — Molecular Adsorbent Recirculating System (MARS). Currently, MARS is a promising trend of liver failure treatment, as it allows support the liver function for a long time until restored or an optimal donor will be found.

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Current Evidence for Extracorporeal Liver Support Systems in Acute Liver Failure and Acute-on-Chronic Liver Failure

Critical Care Clinics ◽

10.1016/j.ccc.2016.03.003 ◽

2016 ◽

Vol 32 (3) ◽

pp. 439-451 ◽

Cited By ~ 24

Author(s):

Constantine J. Karvellas ◽

Ram M. Subramanian

Keyword(s):

Liver Failure ◽

Acute Liver Failure ◽

Support Systems ◽

Chronic Liver ◽

Current Evidence ◽

Chronic Liver Failure ◽

Liver Support ◽

Extracorporeal Liver Support

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The Use of Extracorporeal Liver Support Systems In Acute Decompensated Liver Failure

General Reanimatology ◽

10.15360/1813-9779-2021-4-12-21 ◽

2021 ◽

Vol 17 (4) ◽

pp. 12-21

Author(s):

R. A. Ibadov ◽

Ye. L. Ismailov ◽

S. Kh. Ibragimov

Keyword(s):

Liver Failure ◽

Acute Liver Failure ◽

Organ Failure ◽

Comparison Group ◽

Support Systems ◽

Intensive Therapy ◽

Multiple Organ ◽

Main Group ◽

Liver Support ◽

Extracorporeal Liver Support

The aim of the study: to evaluate the eﬃcacy of extracorporeal liver support systems in patients with acute liver failure of various etiologies.Material and methods. The study included 117 patients with acute liver failure of various etiologies. The main group consisted of 71 patients who received complex intensive therapy, including MARS-therapy and hemodiaﬁltration. The comparison group included 46 patients who received albumin dialysis (24 patients) and hemodiaﬁltration (22 patients) alone. The mean age of the patients was 34±5.6 years, the majority (56.4%) were men. Dynamic assessment of patients' severity was performed using Sequential Organ Failure Assessment (SOFA) and Model for End-Stage Liver Disease (MELD) scales.Results. A more signiﬁcant reduction of SOFA and MELD scores was noted as early as by day 10 of intensive therapy in the main group with sequential use of extracorporeal liver detoxiﬁcation methods — to 2.7±0.2 vs. 8.3±0.5 points (P=0.021) on SOFA and to 16.7±0.4 vs. 23.4±1.4 points (P=0.023) MELD scales. The use of a comprehensive approach to extracorporeal detoxiﬁcation in acute decompensated liver failure increased the regression rate of multiple organ failure from 51.2 to 74.6% and reduced mortality from 47.8 to 25.4% (χ2=6.266; df=1; P=0.013). At the same time, the cumulative proportion of survivors depending on the type of complication within 30 days was 88.4% in the main group and 69.0% in the comparison group (χ2=4.164; df=1; P=0.042).Conclusion. A comprehensive approach to extracorporeal detoxiﬁcation is highly eﬀective, providing a more signiﬁcant reduction of SOFA and MELD scores, increasing the proportion of regression of multiple organ dysfunction and reducing mortality.

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Uncertainty in the impact of liver support systems in acute-on-chronic liver failure: a systematic review and network meta-analysis

Annals of Intensive Care ◽

10.1186/s13613-020-00795-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Klementina Ocskay ◽

Anna Kanjo ◽

Noémi Gede ◽

Zsolt Szakács ◽

Gabriella Pár ◽

...

Keyword(s):

Liver Failure ◽

Support Systems ◽

Meta Analysis ◽

Statistical Significance ◽

Bioartificial Liver ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Liver Support ◽

Bioartificial Liver Support ◽

The Impact

Abstract Background The role of artificial and bioartificial liver support systems in acute-on-chronic liver failure (ACLF) is still controversial. We aimed to perform the first network meta-analysis comparing and ranking different liver support systems and standard medical therapy (SMT) in patients with ACLF. Methods The study protocol was registered with PROSPERO (CRD42020155850). A systematic search was conducted in five databases. We conducted a Bayesian network meta-analysis of randomized controlled trials assessing the effect of artificial or bioartificial liver support systems on survival in patients with ACLF. Ranking was performed by calculating the surface under cumulative ranking (SUCRA) curve values. The RoB2 tool and a modified GRADE approach were used for the assessment of the risk of bias and quality of evidence (QE). Results In the quantitative synthesis 16 trials were included, using MARS®, Prometheus®, ELAD®, plasma exchange (PE) and BioLogic-DT®. Overall (OS) and transplant-free (TFS) survival were assessed at 1 and 3 months. PE significantly improved 3-month OS compared to SMT (RR 0.74, CrI: 0.6–0.94) and ranked first on the cumulative ranking curves for both OS outcomes (SUCRA: 86% at 3 months; 77% at 1 month) and 3-month TFS (SUCRA: 87%) and second after ELAD for 1-month TFS (SUCRA: 76%). Other comparisons did not reach statistical significance. QE was moderate for PE concerning 1-month OS and both TFS outcomes. Other results were of very low certainty. Conclusion PE seems to be the best currently available liver support therapy in ACLF regarding 3-month OS. Based on the low QE, randomized trials are needed to confirm our findings for already existing options and to introduce new devices.

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Therapeutic plasma exchange in children with acute liver failure (ALF): is it time for incorporation into the ALF armamentarium?

Pediatric Nephrology ◽

10.1007/s00467-021-05289-0 ◽

2021 ◽

Author(s):

Emma C. Alexander ◽

Akash Deep

Keyword(s):

Liver Failure ◽

Acute Liver Failure ◽

Plasma Exchange ◽

Controlled Trial ◽

High Volume ◽

Systemic Circulation ◽

Liver Support ◽

Extracorporeal Liver Support ◽

Randomised Controlled ◽

Liver Assist Devices

AbstractPaediatric acute liver failure (PALF) is a rare but devastating condition with high mortality. An exaggerated inflammatory response is now recognised as pivotal in the pathogenesis and prognosis of ALF, with cytokine spill from the liver to systemic circulation implicated in development of multi-organ failure associated with ALF. With advances in medical management, especially critical care, there is an increasing trend towards spontaneous liver regeneration, averting the need for emergency liver transplantation or providing stability to the patient awaiting a graft. Hence, research is ongoing for therapies, including extracorporeal liver support devices, that can bridge patients to transplant or spontaneous liver recovery. Considering the immune-related pathogenesis and inflammatory phenotype of ALF, plasma exchange serves as an ideal liver assist device as it performs both the excretory and synthetic functions of the liver and, in addition, works as an immunomodulatory therapy by suppressing the early innate immune response in ALF. After a recent randomised controlled trial in adults demonstrated a beneficial effect of high-volume plasma exchange on clinical outcomes, this therapy was incorporated in European Association for the Study of Liver (EASL) recommendations for managing adult patients with ALF, but no guidelines exist for PALF. In this review, we discuss rationale, timing, practicalities, and existing evidence regarding the use of plasma exchange as an immunomodulatory treatment in PALF. We discuss controversies in delivery of this therapy as an extracorporeal device, and practicalities of use of plasma exchange as a ‘hybrid’ therapy alongside other extracorporeal liver assist devices, before finally reviewing outstanding research questions for the future.

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Extracorporeal liver support in patients with liver failure: a systematic review and meta-analysis of randomized trials

Intensive Care Medicine ◽

10.1007/s00134-019-05783-y ◽

2019 ◽

Vol 46 (1) ◽

pp. 1-16 ◽

Cited By ~ 8

Author(s):

Fayez Alshamsi ◽

◽

Khalil Alshammari ◽

Emilie Belley-Cote ◽

Joanna Dionne ◽

...

Keyword(s):

Systematic Review ◽

Liver Failure ◽

Randomized Trials ◽

Meta Analysis ◽

Liver Support ◽

Extracorporeal Liver Support

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The Fire from Within: Multiorgan Failure with Bimodal Rhabdomyolysis from Exertional Heat Stroke

Case Reports in Hepatology ◽

10.1155/2020/1305730 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Onion Gerald V. Ubaldo ◽

Khia Quiwa ◽

Rohana Elise Rollan ◽

Edhel Tripon ◽

Elizabeth Sebastian

Keyword(s):

Liver Transplantation ◽

Liver Failure ◽

Liver Transplant ◽

Core Body Temperature ◽

Multiorgan Failure ◽

Heat Stroke ◽

Exertional Heat Stroke ◽

Liver Support ◽

Central Nervous System Dysfunction ◽

Extracorporeal Liver Support

Heat stroke (HS) is a condition characterized by a rise in core body temperature and central nervous system dysfunction. It is divided into two types: classical and exertional. Exertional heat stroke (EHS) is accompanied by organ failure. Liver injury, presenting only with a rise in liver enzymes, is common but in rare conditions, acute liver failure (ALF) may ensue, leading to a potentially lethal condition. Most cases of EHS-induced ALF are managed conservatively. However, liver transplantation is considered for cases refractory to supportive treatment. Identifying patients eligible for liver transplantation in the context of an EHS-induced ALF becomes a medical dilemma since the conventional prognostic criterion may be difficult to apply, and there is paucity of literature about these specific sets of individuals. Recently, extracorporeal liver support has been gaining popularity for patients with liver failure as a bridge to liver transplant. In this case report, we present a young Filipino athlete with symptoms and clinical course consistent with EHS that developed multiorgan failure, initially considered a candidate for liver transplant and total plasma exchange, but clinically improved with supportive management alone. This patient was also found to have bimodal rhabdomyolysis during the course of his hospital stay as manifested by the bimodal rise in his creatine kinase enzymes.

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Acute liver failure

10.1093/med/9780198759928.003.0069 ◽

2018 ◽

Author(s):

Naresh P Shanmugam ◽

Sanjay Bansal

Keyword(s):

Liver Transplantation ◽

Liver Failure ◽

Acute Liver Failure ◽

Support Systems ◽

Liver Support

The chapter on acute liver failure includes the definition, aetiology, and management of this condition. It discusses the frequently associated complications (neurological, haemodynamic, coagulopathy, infectious, and metabolic) and its prognosis, as well as the role of liver transplantation and liver support systems in its management.

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