Is there a liver dialysis, also known as Liver (hepatic) replacement therapy or Artificial Liver Support?

From the Guidelines

Yes, there is liver dialysis, also known as liver support therapy or artificial liver support, which can be used as a bridge to transplant or spontaneous recovery in patients with acute liver failure (ALF) or acute-on-chronic liver failure (ACLF). These systems are designed to temporarily support liver function in patients with severe liver dysfunction. The most common types include the Molecular Adsorbent Recirculating System (MARS), Prometheus system, and Single-Pass Albumin Dialysis (SPAD) [ 1 ].

Key Points

• These therapies work by removing toxins that accumulate when the liver fails, such as ammonia, bilirubin, bile acids, and certain medications.
• Unlike kidney dialysis which is widely available and can permanently replace kidney function, liver dialysis is not as common, typically available only at specialized liver centers.
• The effectiveness of liver dialysis varies depending on the patient's condition and the specific system used, with some studies showing a reduction in mortality, although not always statistically significant [ 1 ].
• These treatments are generally reserved for critically ill patients with severe liver dysfunction who haven't responded to conventional medical management.

Considerations

• The use of artificial liver support is based on local availability, familiarity with its use, and available resources [ 1 ].
• Recent studies suggest that liver support systems may provide a "bridge" to final treatment, such as liver transplantation, which remains the essential therapy in patients with end-stage liver disease [ 1 ].
• Patients with decompensated cirrhosis should be referred to an expert center at an early stage for consideration of liver support therapy [ 1 ].

From the Research

Liver Dialysis Overview

• Liver dialysis, also known as artificial extracorporeal liver support, is a treatment option for patients with severe liver failure 2, 3, 4, 5, 6.
• The goal of liver dialysis is to remove toxins and support the liver's function until it can recover or until a transplant can be performed 2, 3, 4, 5, 6.

Types of Liver Dialysis

• There are several types of liver dialysis devices, including the Molecular Adsorbent Recirculating System (MARS), Prometheus, and SPAD 2, 3, 6.
• MARS uses albumin dialysis to remove toxins, while Prometheus uses fractionated plasma separation via an albumin-permeable filter 6.
• Other types of liver support systems include conventional dialysis, charcoal hemoperfusion, high volume plasma exchange, and bioartificial livers 4.

Clinical Applications

• Liver dialysis is used as a bridge to liver transplantation or to support patients with acute liver failure until their liver can recover 2, 3, 4, 5, 6.
• It is also used to treat acute-on-chronic liver failure, with the goal of achieving clinical stability 5.
• The clinical benefits of liver dialysis include improvement of jaundice, amelioration of hemodynamic instability, reduction of portal hypertension, lowering of intracranial pressure, and improvement of hepatic encephalopathy 2, 3.

Efficacy and Safety

• The efficacy and safety of liver dialysis have been established in several studies, but large randomized controlled trials are still needed to establish its clinical efficacy 2, 3, 5, 6.
• Head-to-head comparisons of MARS and Prometheus have shown that Prometheus is more efficient in removing albumin-bound toxins, but it is not known whether this will translate into clinical benefit 6.