Extracorporeal Liver Support in Patients with Acute Liver Failure

T reatment options for patients with acute liver failure (ALF) are limited to supportive care and liver transplantation. The shortage of donor grafts poses a severe challenge in treating the number of patients who would benefit from transplantation, and those who do receive a transplant face lifelong immunosuppression to prevent rejection. Nonbiological alternatives for support, including plasma exchange and sorbent perfusion systems, have not shown benefit in clinical trials. Effective liver support measures must be designed to treat the causes of ALF, and these factors vary widely. For example, in the United States, acetaminophen overdose caused 46% of reported cases in adults (1998–2007); in Asia and Africa, viral hepatitis is the chief reason. Acute-on-chronic liver failure involves severe deterioration in the presence of cirrhosis, such as in alcoholism. In all these conditions, the goal is to achieve functional stability until recovery or transplantation, and thus the great interest in developing extracorporeal liver support systems.