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Hepatology International

, Volume 8, Supplement 2, pp 505–513 | Cite as

Liver dialysis in acute-on-chronic liver failure: current and future perspectives

  • Rakhi Maiwall
  • Jaswinder Singh Maras
  • Suman Lata Nayak
  • Shiv Kumar SarinEmail author
Supplement Issue: ALPD

Abstract

Patients with acute-on-chronic liver failure (ACLF) are known to have a very high mortality rate as the majority of these patients succumb to multiorgan failure. Liver transplant remains the only option for these patients; however, there are problems with its availability, cost and also the complications and side effects associated with immunosuppression. Unlike advanced decompensated liver disease, there is a potential for hepatic regeneration and recovery in patients with ACLF. A liver support system, cell or non-cell based, logically is likely to provide temporary functional support until the donor liver becomes available or the failing liver survives the onslaught of the acute insult and spontaneously regenerates. Understanding the pathogenesis of liver failure and regeneration is essential to define the needs for a support system. Removal of hepatotoxic metabolites and inhibitors of hepatic regeneration by liver dialysis, a non-cell-based hepatic support, could help to provide a suitable microenvironment and support the failing liver. The current systems, i.e., MARS and Prometheus, have failed to show survival benefits in patients with ACLF based on which newer devices with improved functionality are currently under development. However, larger randomized trials are needed to prove whether these devices can enable restoration of the complex dysregulated immune system and impact organ failure and mortality in these patients.

Keywords

Liver dialysis ACLF Extracorporeal liver support Plasma dialysis 

Notes

Compliance with ethical requirements and Conflict of interest

This article does not contain any studies with human or animal subjects. Rakhi Maiwall, Jaswinder Maras, Suman Lata Nayak and Shiv Kumar Sarin have declared no conflict of interest.

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Copyright information

© Asian Pacific Association for the Study of the Liver 2014

Authors and Affiliations

  • Rakhi Maiwall
    • 1
  • Jaswinder Singh Maras
    • 2
  • Suman Lata Nayak
    • 3
  • Shiv Kumar Sarin
    • 1
    Email author
  1. 1.Department of HepatologyInstitute of Liver and Biliary Sciences (ILBS)New DelhiIndia
  2. 2.Department of ResearchInstitute of Liver and Biliary Sciences (ILBS)New DelhiIndia
  3. 3.Department of NephrologyInstitute of Liver and Biliary Sciences (ILBS)New DelhiIndia

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