From the Guidelines
There is no liver dialysis equivalent to kidney dialysis because the liver performs numerous complex functions that cannot be easily replicated by an external machine. While kidney dialysis primarily filters blood to remove waste products and excess fluid, the liver has over 500 different functions including protein synthesis, detoxification, metabolism, bile production, and storage of essential nutrients. Current liver support systems like MARS (Molecular Adsorbent Recirculating System) and Prometheus can temporarily remove some toxins but cannot replicate the liver's synthetic and metabolic functions, as noted in a study published in 2020 1. These systems serve as bridges to liver transplantation or recovery rather than true replacements. The liver's remarkable regenerative capacity also means that temporary support is often sufficient until the organ can heal itself.
Key Points to Consider
- The liver's complex functions make it difficult to develop a dialysis equivalent
- Current liver support systems have limitations and are used as bridges to transplantation or recovery
- Liver transplantation remains the definitive treatment for severe liver failure, as highlighted in the 2024 EASL clinical practice guidelines on liver transplantation 1
- The development of hepatic regenerative therapies and artificial/bioartificial liver support devices is an area of ongoing research, as noted in the 2024 AASLD practice guidance on acute-on-chronic liver failure and the management of critically ill patients with cirrhosis 1
Treatment Focus
For patients with liver failure, treatment typically focuses on:
- Addressing the underlying cause
- Managing complications
- In severe cases, liver transplantation remains the definitive treatment when the liver cannot recover on its own, with advanced care planning and palliative care playing important roles in patient management 1
From the Research
Liver Dialysis
- There is no established liver dialysis treatment, unlike kidney dialysis, due to the complexity of liver functions and the lack of a reliable technology to replicate them 2.
- Current liver support systems, such as MARS and Prometheus, have failed to show significant survival benefits in patients with acute-on-chronic liver failure, leading to the development of new devices with improved functionality 2.
Acute Liver Failure
- Acute liver failure is a severe and potentially reversible form of liver insufficiency, characterized by the occurrence of hepatic coagulopathy and hepatic encephalopathy in patients with no previous hepatic disease 3.
- The mortality rate for acute liver failure is high, with approximately 47% of patients in Germany not surviving, and liver transplantation remains the only life-saving measure in many cases 3.
Treatment Options
- N-acetylcysteine has been studied as a potential treatment for non-paracetamol-induced acute liver failure, but the evidence is inconclusive, and its use is not widely recommended 4, 5, 6.
- The available evidence suggests that N-acetylcysteine may improve transplant-free survival in specific patient populations, such as those with Coma Grades I-II, but does not improve overall survival 6.
Liver Support Systems
- The development of effective liver support systems is crucial to provide temporary functional support for patients with acute-on-chronic liver failure until a donor liver becomes available or the failing liver regenerates 2.
- Further research is needed to improve the functionality of liver support systems and to determine their effectiveness in reducing mortality and improving outcomes for patients with liver failure 2.