Why is there no liver dialysis?

From the Guidelines

There is no liver dialysis because current technology cannot replicate the liver's complex metabolic, synthetic, and detoxification functions. The liver has over 500 different functions, including protein synthesis, bile production, drug metabolism, glycogen storage, and hormone regulation, making it challenging to create a comprehensive artificial replacement. While some temporary liver support systems exist, such as MARS - Molecular Adsorbent Recirculating System or bioartificial liver devices, they can only perform limited detoxification functions and serve as temporary bridges until liver transplantation or natural recovery occurs, as seen in studies using albumin dialysis with MARS versus standard medical therapy, which showed significant improvement in hepatic encephalopathy and hepatorenal syndrome in a post-hoc analysis 1. However, these systems cannot fully replace liver function the way kidney dialysis substitutes for kidney function. Recent studies, such as the 2022 EASL clinical practice guidelines on the management of hepatic encephalopathy, suggest that albumin dialysis can ameliorate hepatic encephalopathy, but its impact on prognosis is uncertain and further study is warranted 1. Some key points to consider include:

• The complexity of liver physiology, including its regenerative capacity and multifaceted metabolic pathways, makes creating a comprehensive artificial replacement extraordinarily challenging for medical technology.
• Temporary liver support systems can provide a "bridge" to final treatment, such as liver transplantation, which remains the essential therapy in patients with end-stage liver disease, as suggested by experts in the field 1.
• The indications for liver support systems need to be explored, and new research protocols are required to determine their potential benefits and limitations.

From the Research

Liver Dialysis

• There is no established liver dialysis treatment, unlike kidney dialysis, due to the liver's complex functions and its ability to regenerate itself to some extent 2, 3, 4, 5, 6.
• The liver plays a crucial role in detoxification, metabolism, and production of essential proteins, making it challenging to develop a dialysis system that can replicate these functions 3, 4.
• Current treatments for liver failure focus on supporting the patient's overall health, managing complications, and evaluating the need for liver transplantation 2, 3, 4, 5, 6.

Acute Liver Failure

• Acute liver failure (ALF) is a severe condition characterized by rapid deterioration of liver function, often resulting in multi-organ failure and high mortality 3, 4, 6.
• The management of ALF involves optimizing fluid balance, cardiovascular support, and evaluating the need for liver transplantation, particularly for patients with acetaminophen toxicity or other favorable etiologies 3, 4, 6.
• Prognostic scores, such as the Kings Criteria and Model for End-Stage Liver Disease, are used to predict patient outcomes and determine the need for urgent listing for liver transplantation 6.

Acute-on-Chronic Liver Failure

• Acute-on-chronic liver failure (ACLF) is a clinical syndrome that occurs in patients with cirrhosis, characterized by acute deterioration, organ failure, and high short-term mortality 2, 5.
• Alcohol is a leading cause of ACLF, and diagnosis and severity of ACLF determine the prognosis of patients with alcoholic hepatitis (AH) 5.
• Management of ACLF involves corticosteroids as the first-line treatment for severe AH, but novel therapeutic targets are being investigated to contain the excessive inflammatory response and reduce infection 5.