Extracorporeal Liver Support Systems
Keywords:
Hepatic insufficiency, liver, artificial, liver failure, liver failure, acute.
Abstract
Background. Extracorporeal liver support systems (ELS) have emerged as an alternative to liver transplant (LT), given the growing incidence of acute liver failure (ALF), acute-on-chronic liver failure (ACLF) and the limited organ supply.
Objective. Review of literature about Extracorporeal Liver Support Systems.
Methodology. A literature search was conducted on the main medical databases including MEDLINE, SciELO and EMBASE for papers published between July 1990 and November 2010 looking at technologies associated with liver support systems, their technical specifications, their use, and evidence regarding their effectiveness in patients with some forms of liver failure requiring support.
Results. These systems may be divided into artificial (hemofiltration, MARS) and bioartificial (such as the Hepatassist™). They work by replacing detoxification processes associated specifically with bilirubins, aromatic aminoacids, and inflammatory agents, and the elimination of breakdown products of coagulation. Recent advances in bioengineering and biogenetics have brought these technologies closer to the ideal, enabling their use in humans with a relative degree of success. ELS systems, most of them still under development, are designed not only to act as a bridge for LT but may also become the cornerstone of treatment in specific cases while the ALF resolves.
References
1. Bower WA, Johns M, Margolis HS, Williams IT, Bell BP. Population-based surveillance for acute liver failure. Am J Gastroenterol 2007 Nov;102(11):2459-63.
2. Escorsell A, Mas A, De la Mata M. Acute liver failure in Spain: analysis of 267 cases. Liver Transpl 2007 Oct;13(10):1389-95.
3. Bernal W, Auzinger G, Dhawan A, Wendon J. Acute liver failure. Lancet 2010 Jul 17;376(9736):190-201.
4. Sierra F. Acute liver failure: Socratic and hypothetic discussion with the resident. Rev Col Gastroenterol, 2006 Sep;21(3):182-9.
5. Bernal W, Cross TJ, Auzinger G, Sizer E, Heneghan MA, Bowles M, et al. Outcome after wait-listing for emergency liver transplantation in acute liver failure: a single centre experience. J Hepatol 2009 Feb;50(2):306-13.
6. Mas A, Escorsell A, Fernandez J. Liver transplantation for acute liver failure: a spanish perspective. Transplant Proc 2010 Mar;42(2):619-21.
7. Atienza Merino G. Evaluation of extracorporeal liver support systems in the treatment of liver failure. A systematic review. Gastroenterol Hepatol 2010 May;33(5):352-62.
8. Carpentier B, Gautier A, Legallais C. Artificial and bioartificial liver devices: present and future. Gut 2009 Dec;58(12):1690-702.
9. Lafuente S, Bertran MJ, Escorsell A. Artificial liver support. Literature review. Med Clin (Barc) 2010 Apr 21.
10. McKenzie TJ, Lillegard JB, Nyberg SL. Artificial and bioartificial liver support. Semin Liver Dis 2008 May;28(2):210-7.
11. Phua J, Lee KH. Liver support devices. Curr Opin Crit Care 2008 Apr;14(2):208-15.
12. Santoro A, Mancini E, Ferramosca E, Faenza S. Liver support systems. Contrib Nephrol 2007;156:396-404.
13. Stadlbauer V, Jalan R. Acute liver failure: liver support therapies. Curr Opin Crit Care 2007 Apr;13(2): 215-21.
14. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacoterapy: a pathophysiologic approach. 7 ed. (NY): McGraw Hill; 2008.
15. Clemmesen JO, Larsen FS, Kondrup J, Hansen BA, Ott P. Cerebral herniation in patients with acute liver failure is correlated with arterial ammonia concentration. Hepatology 1999 Mar;29(3):648-53.
16. Liu JP, Gluud LL, Als-Nielsen B, Gluud C. Artificial and bioartificial support systems for liver failure. Cochrane Database Syst Rev 2004(1):CD003628.
17. Kobayashi N. Life support of artificial liver: development of a bioartificial liver to treat liver failure. J Hepatobiliary Pancreat Surg 2009;16(2):113-7.
18. Davenport A, Will EJ, Davison AM. Effect of renal replacement therapy on patients with combined acute renal and fulminant hepatic failure. Kidney Int Suppl 1993 Jun;41:S245-51.
19. Catalina-Rodríguez MV, Banares-Canizares R. Artificial liver support systems: update on albumin dialysis (MARS). Gastroenterol Hepatol 2005 Oct;28(8): 453-60.
20. Boyle M, Kurtovic J, Bihari D, Riordan S, Steiner C. Equipment review: the molecular adsorbents recirculating system (MARS). Crit Care 2004 Aug;8(4): 280-6.
21. Isoniemi H, Koivusalo AM, Repo H, Ilonen I, Hockerstedt K. The effect of albumin dialysis on cytokine levels in acute liver failure and need for liver transplantation. Transplant Proc 2005 Mar;37(2):1088-90.
22. Chiu A, Fan ST. MARS in the treatment of liver failure: controversies and evidence. Int J Artif Organs 2006 Jul;29(7):660-7.
23. Guo LM, Liu JY, Xu DZ, Li BS, Han H, Wang LH, et al. Application of Molecular Adsorbents Recirculating System to remove NO and cytokines in severe liver failure patients with multiple organ dysfunction syndrome. Liver Int 2003;23 Suppl 3:16-20.
24. Stadlbauer V, Wright GA, Jalan R. Role of artificial liver support in hepatic encephalopathy. Metab Brain Dis 2009 Mar;24(1):15-26.
25. Ilonen I, Koivusalo AM, Hockerstedt K, Isoniemi H. Albumin dialysis has no clear effect on cytokine levels in patients with life-threatening liver insufficiency. Transplant Proc 2006 Dec;38(10):3540-3.
26. Gaspari R, Avolio AW, Zileri Dal Verme L, Agnes S, Proietti R, Castagneto M, et al. Molecular adsorbent recirculating system in liver transplantation: safety and efficacy. Transplant Proc 2006 Dec;38(10): 3544-51.
27. Kantola T, Koivusalo AM, Hockerstedt K, Isoniemi H. The effect of molecular adsorbent recirculating system treatment on survival, native liver recovery, and need for liver transplantation in acute liver failure patients. Transpl Int 2008 Sep;21(9):857-66.
28. Tan HK. Molecular adsorbent recirculating system (MARS). Ann Acad Med Singapore 2004 May; 33(3): 329-35.
29. Wagholikar GD, Lee KH, Pandey D, Leong SO, Singh R, Tan KC. Pre-transplant optimization by molecular adsorbent recirculating system in patients with severely decompensated chronic liver disease. Indian J Gastroenterol 2007 May-Jun;26(3):110-2.
30. Laleman W, Wilmer A, Evenepoel P, Elst IV, Zeegers M, Zaman Z, et al. Effect of the molecular adsorbent recirculating system and Prometheus devices on systemic haemodynamics and vasoactive agents in patients with acute-on-chronic alcoholic liver failure. Crit Care 2006;10(4):R108.
31. Lai WK, Haydon G, Mutimer D, Murphy N. The effect of molecular adsorbent recirculating system on pathophysiological parameters in patients with acute liver failure. Intensive Care Med 2005 Nov;31(11):1544-9.
32. Donati G, Piscaglia F, Coli L, Silvagni E, Righini R, Pini P, et al. Acute systemic, splanchnic and renal haemodynamic changes induced by molecular adsorbent recirculating system (MARS) treatment in patients with end-stage cirrhosis. Aliment Pharmacol Ther 2007 Sep 1;26(5):717-26.
33. Lee KH, Lee MK, Sutedja DS, Lim SG. Outcome from molecular adsorbent recycling system (MARS) liver dialysis following drug-induced liver failure. Liver Int 2005 Oct;25(5):973-7.
34. Montero JL, Pozo JC, Barrera P, Fraga E, Costan G, Dominguez JL, et al. Treatment of refractory cholestatic pruritus with molecular adsorbent recirculating system (MARS). Transplant Proc 2006 Oct;38(8):2511-3.
35. Schmidt LE, Svendsen LB, Sorensen VR, Hansen BA, Larsen FS. Cerebral blood flow velocity increases during a single treatment with the molecular adsorbents recirculating system in patients with acute on chronic liver failure. Liver Transpl 2001 Aug;7(8):709-12.
36. Stadlbauer V, Davies NA, Sen S, Jalan R. Artificial liver support systems in the management of complications of cirrhosis. Semin Liver Dis 2008 Feb;28(1):96-109.
37. Camus C, Lavoue S, Gacouin A, Le Tulzo Y, Lorho R, Boudjema K, et al. Molecular adsorbent recirculating system dialysis in patients with acute liver failure who are assessed for liver transplantation. Intensive Care Med 2006 Nov;32(11):1817-25.
38. Chiu A, Chan LM, Fan ST. Molecular adsorbent recirculating system treatment for patients with liver failure: the Hong Kong experience. Liver Int 2006 Aug;26(6):695-702.
39. Bachli EB, Schuepbach RA, Maggiorini M, Stocker R, Mullhaupt B, Renner EL. Artificial liver support with the molecular adsorbent recirculating system: activation of coagulation and bleeding complications. Liver Int 2007 May;27(4):475-84.
40. Doria C, Mandala L, Smith JD, Caruana G, Scott VL, Gruttadauria S, et al. Thromboelastography used to assess coagulation during treatment with molecular adsorbent recirculating system. Clin Transplant 2004 Aug;18(4):365-71.
41. Tan HK, Yang WS, Chow P, Lui HF, Choong HL, Wong KS. Anticoagulation minimization is safe and effective in albumin liver dialysis using the molecular adsorbent recirculating system. Artif Organs 2007 Mar;31(3):193-9.
42. Faybik P, Bacher A, Kozek-Langenecker SA, Steltzer H, Krenn CG, Unger S, et al. Molecular adsorbent recirculating system and hemostasis in patients at high risk of bleeding: an observational study. Crit Care 2006 Feb;10(1):R24.
43. Hessel FP. Economic evaluation of the artificial liver support system MARS in patients with acute-on-chronic liver failure. Cost Eff Resour Alloc 2006;4:16.
44. Hessel FP, Bramlage P, Wasem J, Mitzner SR. Cost-effectiveness of the artificial liver support system MARS in patients with acute-on-chronic liver failure. Eur J Gastroenterol Hepatol 2010 Feb;22(2):213-20.
45. Wolff B, Machill K, Schumacher D, Schulzki I. MARS dialysis in decompensated alcoholic liver disease: a single-center experience. Liver Transpl 2007 Aug;13(8):1189-92.
46. Wai CT, Lim SG, Aung MO, Lee YM, Sutedja DS, Dan YY, et al. MARS: a futile tool in centres without active liver transplant support. Liver Int 2007 Feb;27(1): 69-75.
47. Oppert M, Rademacher S, Petrasch K, Jorres A. Extracorporeal liver support therapy with Prometheus in patients with liver failure in the intensive care unit. Ther Apher Dial 2009 Oct;13(5):426-30.
48. Saito A. Current progress in blood purification methods used in critical care medicine. Contrib Nephrol 2010;166:100-11.
49. RifaiK, Ernst T, Kretschmer U, Haller H, Manns MP, Fliser D. Removal selectivity of Prometheus: a new extracorporeal liver support device. World J Gastroenterol 2006 14 Feb ;12(6):940-4.
50. Evenepoel P, Laleman W, Wilmer A, Claes K, Kuypers D, Bammens B, et al. Prometheus versus molecular adsorbents recirculating system: comparison of efficiency in two different liver detoxification devices. Artif Organs 2006 Apr;30(4):276-84.
51. Stadlbauer V, Krisper P, Aigner R, Haditsch B, Jung A, Lackner C, et al. Effect of extracorporeal liver support by MARS and Prometheus on serum cytokines in acute-on-chronic liver failure. Crit Care 2006;10(6):R169.
52. Meyburg J, Hoffmann GF. Liver, liver cell and stem cell transplantation for the treatment of urea cycle defects. Mol Genet Metab 2010;100 Suppl 1:S77-83.
53. Kjaergard LL, Liu J, Als-Nielsen B, Gluud C. Artificial and bioartificial support systems for acute and acute-on-chronic liver failure: a systematic review. JAMA 2003 Jan 8;289(2):217-22.
54. Onodera K, Sakata H, Yonekawa M, Kawamura A. Artificial liver support at present and in the future. J Artif Organs 2006;9(1):17-28.
55. Varo Pérez E, Castroagudin JF. The future of liver transplantation. Transplant Proc 2010 Mar;42(2): 613-6.
2. Escorsell A, Mas A, De la Mata M. Acute liver failure in Spain: analysis of 267 cases. Liver Transpl 2007 Oct;13(10):1389-95.
3. Bernal W, Auzinger G, Dhawan A, Wendon J. Acute liver failure. Lancet 2010 Jul 17;376(9736):190-201.
4. Sierra F. Acute liver failure: Socratic and hypothetic discussion with the resident. Rev Col Gastroenterol, 2006 Sep;21(3):182-9.
5. Bernal W, Cross TJ, Auzinger G, Sizer E, Heneghan MA, Bowles M, et al. Outcome after wait-listing for emergency liver transplantation in acute liver failure: a single centre experience. J Hepatol 2009 Feb;50(2):306-13.
6. Mas A, Escorsell A, Fernandez J. Liver transplantation for acute liver failure: a spanish perspective. Transplant Proc 2010 Mar;42(2):619-21.
7. Atienza Merino G. Evaluation of extracorporeal liver support systems in the treatment of liver failure. A systematic review. Gastroenterol Hepatol 2010 May;33(5):352-62.
8. Carpentier B, Gautier A, Legallais C. Artificial and bioartificial liver devices: present and future. Gut 2009 Dec;58(12):1690-702.
9. Lafuente S, Bertran MJ, Escorsell A. Artificial liver support. Literature review. Med Clin (Barc) 2010 Apr 21.
10. McKenzie TJ, Lillegard JB, Nyberg SL. Artificial and bioartificial liver support. Semin Liver Dis 2008 May;28(2):210-7.
11. Phua J, Lee KH. Liver support devices. Curr Opin Crit Care 2008 Apr;14(2):208-15.
12. Santoro A, Mancini E, Ferramosca E, Faenza S. Liver support systems. Contrib Nephrol 2007;156:396-404.
13. Stadlbauer V, Jalan R. Acute liver failure: liver support therapies. Curr Opin Crit Care 2007 Apr;13(2): 215-21.
14. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacoterapy: a pathophysiologic approach. 7 ed. (NY): McGraw Hill; 2008.
15. Clemmesen JO, Larsen FS, Kondrup J, Hansen BA, Ott P. Cerebral herniation in patients with acute liver failure is correlated with arterial ammonia concentration. Hepatology 1999 Mar;29(3):648-53.
16. Liu JP, Gluud LL, Als-Nielsen B, Gluud C. Artificial and bioartificial support systems for liver failure. Cochrane Database Syst Rev 2004(1):CD003628.
17. Kobayashi N. Life support of artificial liver: development of a bioartificial liver to treat liver failure. J Hepatobiliary Pancreat Surg 2009;16(2):113-7.
18. Davenport A, Will EJ, Davison AM. Effect of renal replacement therapy on patients with combined acute renal and fulminant hepatic failure. Kidney Int Suppl 1993 Jun;41:S245-51.
19. Catalina-Rodríguez MV, Banares-Canizares R. Artificial liver support systems: update on albumin dialysis (MARS). Gastroenterol Hepatol 2005 Oct;28(8): 453-60.
20. Boyle M, Kurtovic J, Bihari D, Riordan S, Steiner C. Equipment review: the molecular adsorbents recirculating system (MARS). Crit Care 2004 Aug;8(4): 280-6.
21. Isoniemi H, Koivusalo AM, Repo H, Ilonen I, Hockerstedt K. The effect of albumin dialysis on cytokine levels in acute liver failure and need for liver transplantation. Transplant Proc 2005 Mar;37(2):1088-90.
22. Chiu A, Fan ST. MARS in the treatment of liver failure: controversies and evidence. Int J Artif Organs 2006 Jul;29(7):660-7.
23. Guo LM, Liu JY, Xu DZ, Li BS, Han H, Wang LH, et al. Application of Molecular Adsorbents Recirculating System to remove NO and cytokines in severe liver failure patients with multiple organ dysfunction syndrome. Liver Int 2003;23 Suppl 3:16-20.
24. Stadlbauer V, Wright GA, Jalan R. Role of artificial liver support in hepatic encephalopathy. Metab Brain Dis 2009 Mar;24(1):15-26.
25. Ilonen I, Koivusalo AM, Hockerstedt K, Isoniemi H. Albumin dialysis has no clear effect on cytokine levels in patients with life-threatening liver insufficiency. Transplant Proc 2006 Dec;38(10):3540-3.
26. Gaspari R, Avolio AW, Zileri Dal Verme L, Agnes S, Proietti R, Castagneto M, et al. Molecular adsorbent recirculating system in liver transplantation: safety and efficacy. Transplant Proc 2006 Dec;38(10): 3544-51.
27. Kantola T, Koivusalo AM, Hockerstedt K, Isoniemi H. The effect of molecular adsorbent recirculating system treatment on survival, native liver recovery, and need for liver transplantation in acute liver failure patients. Transpl Int 2008 Sep;21(9):857-66.
28. Tan HK. Molecular adsorbent recirculating system (MARS). Ann Acad Med Singapore 2004 May; 33(3): 329-35.
29. Wagholikar GD, Lee KH, Pandey D, Leong SO, Singh R, Tan KC. Pre-transplant optimization by molecular adsorbent recirculating system in patients with severely decompensated chronic liver disease. Indian J Gastroenterol 2007 May-Jun;26(3):110-2.
30. Laleman W, Wilmer A, Evenepoel P, Elst IV, Zeegers M, Zaman Z, et al. Effect of the molecular adsorbent recirculating system and Prometheus devices on systemic haemodynamics and vasoactive agents in patients with acute-on-chronic alcoholic liver failure. Crit Care 2006;10(4):R108.
31. Lai WK, Haydon G, Mutimer D, Murphy N. The effect of molecular adsorbent recirculating system on pathophysiological parameters in patients with acute liver failure. Intensive Care Med 2005 Nov;31(11):1544-9.
32. Donati G, Piscaglia F, Coli L, Silvagni E, Righini R, Pini P, et al. Acute systemic, splanchnic and renal haemodynamic changes induced by molecular adsorbent recirculating system (MARS) treatment in patients with end-stage cirrhosis. Aliment Pharmacol Ther 2007 Sep 1;26(5):717-26.
33. Lee KH, Lee MK, Sutedja DS, Lim SG. Outcome from molecular adsorbent recycling system (MARS) liver dialysis following drug-induced liver failure. Liver Int 2005 Oct;25(5):973-7.
34. Montero JL, Pozo JC, Barrera P, Fraga E, Costan G, Dominguez JL, et al. Treatment of refractory cholestatic pruritus with molecular adsorbent recirculating system (MARS). Transplant Proc 2006 Oct;38(8):2511-3.
35. Schmidt LE, Svendsen LB, Sorensen VR, Hansen BA, Larsen FS. Cerebral blood flow velocity increases during a single treatment with the molecular adsorbents recirculating system in patients with acute on chronic liver failure. Liver Transpl 2001 Aug;7(8):709-12.
36. Stadlbauer V, Davies NA, Sen S, Jalan R. Artificial liver support systems in the management of complications of cirrhosis. Semin Liver Dis 2008 Feb;28(1):96-109.
37. Camus C, Lavoue S, Gacouin A, Le Tulzo Y, Lorho R, Boudjema K, et al. Molecular adsorbent recirculating system dialysis in patients with acute liver failure who are assessed for liver transplantation. Intensive Care Med 2006 Nov;32(11):1817-25.
38. Chiu A, Chan LM, Fan ST. Molecular adsorbent recirculating system treatment for patients with liver failure: the Hong Kong experience. Liver Int 2006 Aug;26(6):695-702.
39. Bachli EB, Schuepbach RA, Maggiorini M, Stocker R, Mullhaupt B, Renner EL. Artificial liver support with the molecular adsorbent recirculating system: activation of coagulation and bleeding complications. Liver Int 2007 May;27(4):475-84.
40. Doria C, Mandala L, Smith JD, Caruana G, Scott VL, Gruttadauria S, et al. Thromboelastography used to assess coagulation during treatment with molecular adsorbent recirculating system. Clin Transplant 2004 Aug;18(4):365-71.
41. Tan HK, Yang WS, Chow P, Lui HF, Choong HL, Wong KS. Anticoagulation minimization is safe and effective in albumin liver dialysis using the molecular adsorbent recirculating system. Artif Organs 2007 Mar;31(3):193-9.
42. Faybik P, Bacher A, Kozek-Langenecker SA, Steltzer H, Krenn CG, Unger S, et al. Molecular adsorbent recirculating system and hemostasis in patients at high risk of bleeding: an observational study. Crit Care 2006 Feb;10(1):R24.
43. Hessel FP. Economic evaluation of the artificial liver support system MARS in patients with acute-on-chronic liver failure. Cost Eff Resour Alloc 2006;4:16.
44. Hessel FP, Bramlage P, Wasem J, Mitzner SR. Cost-effectiveness of the artificial liver support system MARS in patients with acute-on-chronic liver failure. Eur J Gastroenterol Hepatol 2010 Feb;22(2):213-20.
45. Wolff B, Machill K, Schumacher D, Schulzki I. MARS dialysis in decompensated alcoholic liver disease: a single-center experience. Liver Transpl 2007 Aug;13(8):1189-92.
46. Wai CT, Lim SG, Aung MO, Lee YM, Sutedja DS, Dan YY, et al. MARS: a futile tool in centres without active liver transplant support. Liver Int 2007 Feb;27(1): 69-75.
47. Oppert M, Rademacher S, Petrasch K, Jorres A. Extracorporeal liver support therapy with Prometheus in patients with liver failure in the intensive care unit. Ther Apher Dial 2009 Oct;13(5):426-30.
48. Saito A. Current progress in blood purification methods used in critical care medicine. Contrib Nephrol 2010;166:100-11.
49. RifaiK, Ernst T, Kretschmer U, Haller H, Manns MP, Fliser D. Removal selectivity of Prometheus: a new extracorporeal liver support device. World J Gastroenterol 2006 14 Feb ;12(6):940-4.
50. Evenepoel P, Laleman W, Wilmer A, Claes K, Kuypers D, Bammens B, et al. Prometheus versus molecular adsorbents recirculating system: comparison of efficiency in two different liver detoxification devices. Artif Organs 2006 Apr;30(4):276-84.
51. Stadlbauer V, Krisper P, Aigner R, Haditsch B, Jung A, Lackner C, et al. Effect of extracorporeal liver support by MARS and Prometheus on serum cytokines in acute-on-chronic liver failure. Crit Care 2006;10(6):R169.
52. Meyburg J, Hoffmann GF. Liver, liver cell and stem cell transplantation for the treatment of urea cycle defects. Mol Genet Metab 2010;100 Suppl 1:S77-83.
53. Kjaergard LL, Liu J, Als-Nielsen B, Gluud C. Artificial and bioartificial support systems for acute and acute-on-chronic liver failure: a systematic review. JAMA 2003 Jan 8;289(2):217-22.
54. Onodera K, Sakata H, Yonekawa M, Kawamura A. Artificial liver support at present and in the future. J Artif Organs 2006;9(1):17-28.
55. Varo Pérez E, Castroagudin JF. The future of liver transplantation. Transplant Proc 2010 Mar;42(2): 613-6.
How to Cite
1.
Ariza Cadena F, Carmona Serna LF, Quintero C. IF, Caicedo LA, Vidal Perdomo CA, González LF. Extracorporeal Liver Support Systems. Colomb. J. Anesthesiol. [Internet]. 2011 Oct. 1 [cited 2024 Apr. 19];39(4):528-43. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/683
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2011-10-01
How to Cite
1.
Ariza Cadena F, Carmona Serna LF, Quintero C. IF, Caicedo LA, Vidal Perdomo CA, González LF. Extracorporeal Liver Support Systems. Colomb. J. Anesthesiol. [Internet]. 2011 Oct. 1 [cited 2024 Apr. 19];39(4):528-43. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/683
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