From the Guidelines
Liver dialysis is not a commonly used treatment due to its limited effectiveness and high cost, and its use should be reserved for patients with acute liver failure expected to recover or as a bridge therapy for those awaiting liver transplantation. The liver performs complex functions including protein synthesis, metabolism, and detoxification that current technology cannot adequately replicate. Liver dialysis systems like MARS (Molecular Adsorbent Recirculating System) and Prometheus can temporarily remove toxins from the blood when the liver fails, but they have not demonstrated any benefit on survival at 28 and 90 days in patients with acute decompensation compared to standard medical treatment 1. However, a significant improvement in hepatic encephalopathy and hepatorenal syndrome was seen in a post-hoc analysis using albumin dialysis with MARS versus standard medical therapy 1.
The cost of liver dialysis is also a significant factor, with treatments typically costing $8,000-$15,000 per session, and patients often needing multiple sessions. Most healthcare systems and insurance providers consider liver dialysis experimental and may not cover it. The equipment requires specialized training to operate and is only available at select medical centers. Some studies have shown that use of an artificial liver support system was associated with improved short-term survival (14-day and 28-day) in patients with ACLF and multiple organ failure 1.
Key points to consider when evaluating the use of liver dialysis include:
- The patient's underlying liver disease and potential for recovery
- The presence of multiple organ failures and the patient's overall prognosis
- The availability and cost of liver dialysis treatment
- The potential for liver transplantation as a definitive treatment option
- The need for specialized training and equipment to operate liver dialysis systems.
In general, liver dialysis should be used with caution and only in select cases where the potential benefits outweigh the costs and risks, and patients should be referred to an expert centre at an early stage after decompensation of their cirrhosis 1.
From the Research
Liver Dialysis Overview
- Liver dialysis, also known as liver support systems, is a treatment option for patients with liver failure, including acute-on-chronic liver failure (ACLF) and end-stage cirrhosis 2, 3.
- The goal of liver dialysis is to provide temporary functional support to the liver until a donor liver becomes available or the failing liver recovers 2.
Types of Liver Dialysis
- There are several types of liver dialysis, including:
Efficacy and Safety of Liver Dialysis
- Studies have shown that liver dialysis can improve hepatic encephalopathy and reduce serum bilirubin levels, but its effect on overall survival is unclear 3, 4.
- The safety of liver dialysis has been evaluated, but the reporting of adverse events is inconsistent, making it difficult to draw conclusions 4.
Limitations and Cost-Effectiveness of Liver Dialysis
- Liver dialysis is not commonly used due to its high cost and limited availability 2, 3.
- The technique should be limited to patients with a transplant project, and its use should be restricted to centers experienced in the management of advanced liver disease 3.
- The cost-effectiveness of liver dialysis is a concern, and larger randomized trials are needed to evaluate its effectiveness and safety 2, 3.
Patient Selection and Treatment Modalities
- Patient selection is crucial for the effective use of liver dialysis, and careful consideration should be given to the patient's underlying condition and potential for recovery 3, 6.
- The use of extracorporeal albumin dialysis may be beneficial in selected patients with advanced liver diseases listed for transplant or with a transplant project 3.