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 for transplantation.
Liver Support Systems
Liver Support Systems are the support devices the help a failing liver to recover. These devices can also be used as a bridge to transplantation. There are two kinds of devices sorbent based artificial system and cell based bio-artificial system. There is no good evidence showing low mortality with their use in acute liver failure[1]. They are not recommended outside of clinical trials as of now.
- Artificial Systems
These are sorbent-based systems help in detoxification. They may use charcoal or sorbents like albumin. It uses the principles of plasmapheresis. They are most useful in reducing effects in hepatic encephalopathy due to their detoxification effect.
- Bio-Artificial Systems
These are cell based systems. These use cells (hepatocytes of human or mammalian origin) in a cartridge or circuit fashion. Five systems have be tried and published their data. No system has shown 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 under trials and no evidence of good prognosis is 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
- ↑ 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. doi:10.1111/j.1600-6143.2008.02174.x. PMID 18336699. Retrieved 2012-10-26. Unknown parameter
|month=ignored (help) - ↑ 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. doi:10.1002/hep.510240625. PMID 8938179. Retrieved 2012-10-26. Unknown parameter
|month=ignored (help) - ↑ 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. doi:10.1056/NEJM199407283310404. PMID 8015570. Retrieved 2012-10-26. Unknown parameter
|month=ignored (help) - ↑ 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. doi:10.1053/j.gastro.2011.11.027. PMID 22119930. Retrieved 2012-10-26. Unknown parameter
|month=ignored (help) - ↑ 5.0 5.1 "www.aasld.org" (PDF). Retrieved 2012-10-26.