Acute liver failure future or investigational therapies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Overview

Liver support systems can help support patients until the liver recovers or can be used as a bridging aid in transplant patients.

Future or Investigational Therapies

Liver Support Systems

Liver Support Systems are support devices that compensate for a failing liver. These devices can also be used as a bridging aid in transplant patients. There are two kinds of devices: sorbent-based artificial systems and cell-based bio-artificial systems. There is no good evidence showing low mortality with the use of either system in acute liver failure[1].

Artificial Systems

These are sorbent-based systems that assist in detoxification. They may use charcoal or other sorbents like albumin. Such systems operate on the principles of plasmapheresis. They are most useful in reducing effects in hepatic encephalopathy due to their efficacy in detoxification.

Bio-Artificial Systems

These are cell-based systems. These systems use cells (hepatocytes of human or mammalian origin) in a cartridge or circuit fashion. There is published data on five systems. No system has yet to show any survival advantage. [2]

Other Strategies

Other strategies include exchange transfusion, charcoal hemoperfusion, extracorporeal liver perfusions[2][3], and intra-portal hepatocyte infusions[4]. All these are still being evaluated in trials and no evidence of good prognosis has been demonstrated.

2011 AASLD Recommendations for Acute Liver Failure (DO NOT EDIT)[5]

Liver Support Systems (DO NOT EDIT)[5]

Class II-1
1. Currently available liver support systems are not recommended outside of clinical trials; their future in the management of acute liver failure remains unclear.





References

  1. Freeman RB, Steffick DE, Guidinger MK, Farmer DG, Berg CL, Merion RM (2008). "Liver and intestine transplantation in the United States, 1997-2006". American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 8 (4 Pt 2): 958–76. PMID 18336699. doi:10.1111/j.1600-6143.2008.02174.x. Retrieved 2012-10-26. 
  2. 2.0 2.1 Ellis AJ, Hughes RD, Wendon JA, Dunne J, Langley PG, Kelly JH, Gislason GT, Sussman NL, Williams R (1996). "Pilot-controlled trial of the extracorporeal liver assist device in acute liver failure". Hepatology (Baltimore, Md.). 24 (6): 1446–51. PMID 8938179. doi:10.1002/hep.510240625. Retrieved 2012-10-26. 
  3. Chari RS, Collins BH, Magee JC, DiMaio JM, Kirk AD, Harland RC, McCann RL, Platt JL, Meyers WC (1994). "Brief report: treatment of hepatic failure with ex vivo pig-liver perfusion followed by liver transplantation". The New England Journal of Medicine. 331 (4): 234–7. PMID 8015570. doi:10.1056/NEJM199407283310404. Retrieved 2012-10-26. 
  4. Garg V, Garg H, Khan A, Trehanpati N, Kumar A, Sharma BC, Sakhuja P, Sarin SK (2012). "Granulocyte colony-stimulating factor mobilizes CD34(+) cells and improves survival of patients with acute-on-chronic liver failure". Gastroenterology. 142 (3): 505–512.e1. PMID 22119930. doi:10.1053/j.gastro.2011.11.027. Retrieved 2012-10-26. 
  5. 5.0 5.1 "www.aasld.org" (PDF). Retrieved 2012-10-26. 



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