engleski

The use of extracorporeal liver support systems in acute liver failure

Acute liver failure, irrespective of its etiology, is often followed by rapidly progressive multi- organ failure, such as peripheral and central circulation disorders, encephalopathy and renal dysfunction. According to the so-called "toxin hypotheses", these manifestations are the result of loss of detoxifying liver function, leading to accumulation of water-soluble but also vasoactive toxins that are bound to the albumin. Therefore, the concept of albumin dialysis is of major interest. The rationale of any liver support therapy is to support liver function to prevent or reverse secondary organ failure complications and to promote restoration of liver function through regeneration. Additionally, it may provide the crucial bridge for survival to transplantation. To date, the most widely developed system has been the Molecular Adsorbent Recirculating System (MARS), the Prometheus and the SinglePass Albumin Dialysis (SPAD) systems. Use of these systems was shown to be associated with recovery of hemodynamics (decreased vasopressor dependence, improved renal perfusion, increased cardiac index), decreased serum bilirubin, urea, creatinine, bile salts and ammonia concentrations (as well as other toxins that are not routinely measured), improvement of encephalopathy and reduction of intracranial pressure, improvement of renal function and of coagulation. Although there was no improvement of survival in the majority of studies, patients with secondary liver failure duo to sepsis might benefit from artificial liver support systems. Technical improvements and randomized controlled trials focusing on specific indications for infectious diseases are still needed to evaluate the impact of these therapies in medical practice.

Extracorporeal liver support systems, acute, liver, failure

nije evidentirano