Abstract
Recognition of acute-on-chronic liver failure (ACLF) as a unique entity is slowly
evolving, as are therapies to improve survival of affected patients. Further investigation
into its disease process and proper treatments with critical timing are important
for improving patient survival. At this time, liver transplant is the only treatment
known to improve survival in liver-failure patients. However, liver transplantation
has its own disadvantages, such as organ shortage and the need for lifelong immunotherapy.
Bridging therapies such as extracorporeal liver-support systems are attractive options
to stabilize patients until transplantation or spontaneous recovery. The goals of
these liver-support systems are to remove detoxification products, reduce systemic
inflammation, and enhance regeneration of the injured liver. These devices have been
under development for the past decade; a few are in clinical trials. At this time,
there is no proven clearcut survival benefit in these devices, but they may improve
the outcome of challenging cases and potentially avoid or postpone liver transplantation
in some cases.
Keywords
acute-on-chronic liver failure - artificial liver-support systems - bioartificial
liver-support systems - liver transplant
