Acute-on-chronic liver failure: extracorporeal liver assist devices

@article{Hassanein2011AcuteonchronicLF,
  title={Acute-on-chronic liver failure: extracorporeal liver assist devices},
  author={Tarek I. Hassanein and Robert R. Schade and Iryna S. Hepburn},
  journal={Current Opinion in Critical Care},
  year={2011},
  volume={17},
  pages={195–203}
}
Purpose of reviewAcute-on-chronic liver failure (ACLF), a syndrome precipitated by acute liver injury in patients with advanced cirrhosis, is associated with multiorgan dysfunction and high rates of mortality. Liver support systems have been developed in an attempt to improve survival of patients with ACLF by providing a bridge until recovery of the native liver function. Recent findingsNonbiological devices such as molecular adsorbent recirculating system (MARS) and fractionated plasma… 
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References

SHOWING 1-10 OF 79 REFERENCES
[Liver support systems today].
TLDR
Although the results of many experimental and clinical trials prove the efficacy of the above mentioned methods, large randomized controlled trials are mandatory to establish the impact on survival benefit of artificial and bioartificial support systems versus standard therapy.
Effect of extracorporeal liver support by MARS and Prometheus on serum cytokines in acute-on-chronic liver failure
TLDR
Cytokines are cleared from plasma by both MARS and Prometheus, but neither system is able to change serum cytokine levels, probably due to a high rate of cytokine production in patients with ACLF.
Reversal of fulminant hepatic failure using an extracorporeal liver assist device
TLDR
A device consisting of a highly differentiated human liver cell line cultured in a hollow fiber cartridge is capable of supporting dogs with acetaminopheninduced fulminant hepatic failure for a period long enough for their own livers to resume function, allowing recovery of hepatocytes that would otherwise have lysed.
Extracorporeal detoxification using the molecular adsorbent recirculating system for critically ill patients with liver failure.
TLDR
It is concluded that the molecular adsorbent recirculating system can contribute to the treatment of critically ill patients with liver failure and different underlying diseases.
Prospective, Randomized, Multicenter, Controlled Trial of a Bioartificial Liver in Treating Acute Liver Failure
TLDR
This is the first prospective, randomized, controlled trial of an extracorporeal liver support system, demonstrating safety and improved survival in patients with fulminant/subfulminant hepatic failure.
Bioartificial liver systems: why, what, whither?
TLDR
A novel bioreactor design is described that closely mimics the native liver cell environment and is easily scaled from microscopic (<1 ml cells) to clinical size, while maintaining the same local cell environment throughout theBioreactor.
Initial experience with the modified extracorporeal liver-assist device for patients with fulminant hepatic failure: system modifications and clinical impact
TLDR
The patients tolerated treatment with the ELAD well, and the results from this single-institution experience indicates that larger randomized multicenter trials should proceed.
Early Experiences with a Porcine Hepatocyte-based Bioartificial Liver in Acute Hepatic Failure Patients
TLDR
Initial clinical experience confirms the safety of this hepatocyte-based bioartificial liver configuration and suggests its clinical efficacy as a temporary liver support system in AHF patients.
Improvement of hepatorenal syndrome with extracorporeal albumin dialysis mars: Results of a prospective, randomized, controlled clinical trial
  • S. Mitzner, J. Stange, R. Schmidt
  • Medicine
    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
  • 2000
TLDR
It is concluded that the removal of albumin‐bound substances with the MARS method can contribute to the treatment of type I HRS.
...
1
2
3
4
5
...