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Use of Extra-Corporeal Liver Support Therapies in Acute and Acute on Chronic Liver Failure

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Hepatic Critical Care

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Abstract

Artificial (non-biological) extracorporeal liver support (ECLS) devices aim to remove albumin-bound and water soluble toxins in order to restore and preserve hepatic function and mitigate or limit the progression of multiorgan failure while either hepatic recovery or liver transplant occurs. Current artificial ECLS devices differ primarily in selectivity of the membrane utilized; dialysis based techniques such as the molecular adsorbent recirculating system (MARS®) combine renal replacement therapy with albumin dialysis and a highly selective (<50 kDa) filter in contrast to plasmapheresis (HVP)/plasma separation and filtration (Prometheus) techniques which are less selective (~250 kDa). Artificial ECLS devices have been used to support patients with acute liver failure (ALF) and acute-on-chronic liver failure (ACLF). These devices have been shown to be safe. The following beneficial effects have been documented: improvement of jaundice, amelioration of haemodynamic instability, reduction of portal hypertension, and improvement of hepatic encephalopathy. However, the only randomized prospective multicenter controlled trial to show an improvement in transplant-free survival was for HVP. Biological (cell based) extracorporeal liver support systems (B-ECLS) aim to support the failing liver both through detoxification and synthetic function and warrant further study for safety and benefit.

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Abbreviations

ACLF:

Acute on chronic liver failure

ALF:

Acute liver failure

ECLS:

Extracorporeal liver support

FPSA:

Fractionated plasma separation and adsorption

HE:

Hepatic encephalopathy

HRS:

Hepatorenal syndrome

INR:

International normalised ratio

LT:

Liver transplantation

MAP:

Mean arterial pressure

MARS® :

Molecular adsorbent recirculation system

SBP:

Spontaneous bacterial peritonitis

SMT:

Standard medical therapy

SOFA:

Sequential organ failure assessment score

SPAD:

Single pass albumin dialysis

SVRI:

Systemic vascular resistance index

TNF:

Tumor necrosis factor

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Acknowledgements

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Author information

Authors and Affiliations

  1. Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada

    Constantine J. Karvellas M.D., S.M., F.R.C.P.C.

  2. Division of Gastroenterology (Liver Unit), Division of Critical Care Medicine, University of Alberta, 1-40 Zeidler Ledcor Building, Edmonton, AB, T6G-2X8, Canada

    Constantine J. Karvellas M.D., S.M., F.R.C.P.C.

  3. Division of Hepatology, University of Kansas, Kansas City, MO, USA

    Jody C. Olson M.D.

  4. Division of Critical Care Medicine, University of Kansas, Kansas City, MO, USA

    Jody C. Olson M.D.

  5. Division of Hepatology, Emory University, Atlanta, GA, USA

    Ram M. Subramanian M.D.

  6. Division of Critical Care Medicine, Emory University, Atlanta, GA, USA

    Ram M. Subramanian M.D.

Authors
  1. Constantine J. Karvellas M.D., S.M., F.R.C.P.C.
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  2. Jody C. Olson M.D.
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  3. Ram M. Subramanian M.D.
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Corresponding author

Correspondence to Constantine J. Karvellas M.D., S.M., F.R.C.P.C. .

Editor information

Editors and Affiliations

  1. Medical Intensive Care Unit, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Rahul Nanchal

  2. Emory University, Atlanta, Georgia, USA

    Ram Subramanian

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Karvellas, C.J., Olson, J.C., Subramanian, R.M. (2018). Use of Extra-Corporeal Liver Support Therapies in Acute and Acute on Chronic Liver Failure. In: Nanchal, R., Subramanian, R. (eds) Hepatic Critical Care . Springer, Cham. https://doi.org/10.1007/978-3-319-66432-3_21

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  • DOI: https://doi.org/10.1007/978-3-319-66432-3_21

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  • Print ISBN: 978-3-319-66431-6

  • Online ISBN: 978-3-319-66432-3

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