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Semin Respir Crit Care Med 2012; 33(01): 70-79
DOI: 10.1055/s-0032-1301736
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Liver Replacement Therapy

Giovanni Tritto
1   Liver Failure Group, Institute of Hepatology, University College London Medical School, Royal Free Hospital, London, United Kingdom.
,
Nathan A. Davies
1   Liver Failure Group, Institute of Hepatology, University College London Medical School, Royal Free Hospital, London, United Kingdom.
,
Rajiv Jalan
1   Liver Failure Group, Institute of Hepatology, University College London Medical School, Royal Free Hospital, London, United Kingdom.
› Author Affiliations
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Publication History

Publication Date:
23 March 2012 (online)

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Abstract

The realization of a support device able to effectively replace liver function in patients with hepatic failure has thus far been an elusive goal. The complexity of liver metabolic, synthetic, detoxifying, and excretory functions make artificial hepatic support extremely challenging. Currently, no specific treatment is available to reverse acute or acute-on-chronic liver failure, and morbidity and mortality of these syndromes are still high. Present management strategies are supportive, while waiting for spontaneous liver regeneration or liver transplant. Because of the scarcity of donor organs, liver support strategies are needed for patients with inadequate liver function until an appropriate organ becomes available for transplantation or until their liver recovers from injury. Currently available liver support systems comprise nonbiological systems (e.g., hemodiafiltration, albumin dialysis, and plasma exchange) and bioartificial systems utilizing viable liver cells. The role for these novel systems and their impact on survival or other clinically important outcomes are controversial. Development and use of bioartificial systems are limited by the inherent cost.

Keywords

liver failure - extracorporeal liver support - albumin dialysis - bioartificial liver
 

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