From the Guidelines
A liver pump, in the context of recent medical literature, refers to artificial liver support systems used to bridge patients with acute liver failure (ALF) or acute-on-chronic liver failure (ACLF) to transplant or spontaneous recovery, rather than a device for delivering chemotherapy directly to the liver. These systems, such as the Molecular Adsorbent Recirculating System (MARS) and the Prometheus system, are designed to remove albumin-bound substances and other toxins that accumulate in liver failure, potentially improving organ function and patient survival. The decision to use a liver pump should be based on local availability, familiarity with its use, and available resources, as indicated by recent guidelines 1. Key considerations include:
- The potential for these systems to act as a bridge to liver transplantation or recovery, particularly in patients with severe liver disease and multiorgan failure.
- The lack of significant survival benefit demonstrated in some randomized controlled trials (RCTs) for patients with ACLF, although certain subgroups may derive benefit, such as those with higher Model for End-Stage Liver Disease (MELD) scores 1.
- The importance of early referral to an expert center for patients with decompensated cirrhosis to explore the potential benefits of liver support systems and transplantation 1. Given the complexity and the variability in patient response, the use of a liver pump should be individualized, considering the latest evidence and the specific clinical context of the patient, with a focus on improving morbidity, mortality, and quality of life. Recent studies, such as those published in 2023, highlight the ongoing evolution in the management of liver failure, emphasizing the need for personalized approaches and the consideration of artificial liver support as part of a broader therapeutic strategy 1.
From the Research
Definition of Liver Pump
There is no direct reference to a "liver pump" in the provided studies. However, the studies discuss various artificial liver support devices that can be considered as a form of "liver pump" in the sense that they support liver function.
Types of Artificial Liver Support Devices
- Artificial liver support devices aim to remove albumin-bound and water-soluble toxins arising as a result of liver failure 2
- These devices do not directly improve the liver synthetic capacity 2
- Examples of artificial liver support devices include:
Function of Artificial Liver Support Devices
- These devices can remove damaging toxins that further aggravate liver failure, stimulate regeneration of the liver, and improve pathophysiologic consequences of liver failure 5
- They can be used as a bridge to liver transplantation or as a bridge to spontaneous recovery 2, 4, 5
- They have been used to treat different types of liver failure, including acute liver failure, acute-on-chronic liver failure, and primary non- or poor-function after liver transplantation 2