Agarwal, B; Jalan, R; (2016) Extracorporeal liver support devices in the ICU. In: Oxford Textbook of Critical Care. Oxford University Press: Oxford, UK.

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Abstract

Liver failure is common and carries high morbidity and mortality. Liver transplantation (LT) is the only definitive treatment available performed as an emergency in acute liver failure and electively for chronic liver disease. In the last 50 years, a number of extracorporeal liver support devices and modifications have emerged , some of them purely mechanical in nature aimed at detoxification, while others are cell based systems possessing bio-transformational capability. Mechanical devices are mainly based on albumin dialysis, albumin being a key transporter protein that is severely deficient and irreversibly destroyed in liver diseases. Despite a sound scientific rationale and good safety profile, none of the currently available devices have shown enough promise to be incorporated in routine clinical practice, their use being limited to specific clinical situations. This chapter describes currently available devices, their operational characteristics, current evidence of their utility and limitation, and the future developments in the field of extracorporeal liver support.

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