Systematic review and meta‐analysis of survival following extracorporeal liver support

@article{Stutchfield2011SystematicRA,
  title={Systematic review and meta‐analysis of survival following extracorporeal liver support},
  author={Benjamin M Stutchfield and Ken Simpson and Stephen J. Wigmore},
  journal={British Journal of Surgery},
  year={2011},
  volume={98}
}
Extracorporeal liver support (ELS) systems offer the potential to prolong survival in acute and acute‐on‐chronic liver failure. However, the literature has been unclear on their specific role and influence on mortality. This meta‐analysis aimed to test the hypothesis that ELS improves survival in acute and acute‐on‐chronic liver failure. 
Current Evidence for Extracorporeal Liver Support Systems in Acute Liver Failure and Acute-on-Chronic Liver Failure.
TLDR
Biological (cell-based) extracorporeal liver support systems aim to support the failing liver through detoxification and synthetic function and warrant further study for safety and benefit.
Survival Benefits With Artificial Liver Support System for Acute-on-Chronic Liver Failure
TLDR
A time series-based meta-analysis of randomized clinical trials (RCTs) and observational studies which examined differences in mortality in ACLF patients treated with ALSS found that ALSS therapy could reduce short-term mortality in patients with ACLF.
Extracorporeal liver support in patients with liver failure: a systematic review and meta-analysis of randomized trials
TLDR
ECLS may reduce mortality and improve HE in patients with ALF and ACLF and the effect on other outcomes is uncertain, but the evidence is limited by risk of bias and imprecision and larger trials are needed to better determine the effect of ECLS on patient-important outcomes.
Efficacy and safety of liver support devices in acute and hyperacute liver failure: a systematic review and network meta-analysis.
TLDR
Network meta-analysis found MARS therapy seems to be the best available option in reducing mortality in adults with acute or hyperacute liver failure, and there were no statistically significant differences between the interventions in the outcomes.
Bioartificial liver support systems for acute liver failure: A systematic review and meta-analysis of the clinical and preclinical literature
TLDR
BAL may reduce the mortality of ALF by bridging the gap between preclinical experiments and clinical trials, and Clinical trials using improved BAL must be designed scientifically and conducted in the future to provide evidence for transformation.
Role of liver support systems in the management of post hepatectomy liver failure: A systematic review of the literature
TLDR
There is a definite need for larger, multicenter, prospective studies, evaluating the conventional and newer modalities of support systems, with a view to improve the outcomes in this group of patients.
Is there a role for extracorporeal liver support as a bridge to liver transplantation in acute liver failure?
TLDR
These data demonstrate that although there is a role for prolonging survival to transplantation in ALF, the majority of patients do undergo liver transplantation promptly, and in countries where donor pools are more limited, the proportion of patients with ALF dying before transplantation may be higher.
Extracorporeal Devices.
TLDR
Patients with acute liver failure and acute-on-chronic liver failure stand to benefit from these devices, especially because they have lost many of the primary functions of the liver, including detoxifying the blood of various endogenous and exogenous substances, manufacturing circulating proteins, secreting bile, and storing energy.
Uncertainty in the impact of liver support systems in acute-on-chronic liver failure: a systematic review and network meta-analysis
TLDR
PE seems to be the best currently available liver support therapy in ACLF regarding 3-month OS, and randomized trials are needed to confirm the findings for already existing options and to introduce new devices.
Emerging Role of Extracorporeal Support in Acute and Acute-on-Chronic Liver Failure: Recent Developments.
TLDR
Only one prospective randomized controlled trial examining the use of high-volume plasma exchange has demonstrated improvement in transplant-free survival, and bioartificial ECLS platforms offer the greatest potential for future development.
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