Abstract
The multifunctional and complex nature of the liver is reflected in the severity of physiological derangement that occurs in liver failure. Effective treatment modalities outside of liver transplantation are lacking; however, the shortage of suitable organs for transplantation, the high mortality of liver failure without transplantation, and the morbidity and mortality associated with transplantation have provided the impetus to develop an effective liver support device. The quest for such device(s) has been ongoing for more than 50 years, focusing on approaches based on cell-based (bio-artificial), cell-free (artificial), or a combination of the two systems. Bio-artificial devices aim to replace the whole gamut of liver functions (synthesis, biotransformation, detoxification, and excretion) through the use of cultured hepatocytes, whereas artificial devices predominantly employ blood purification and detoxification strategy through processes targeting albumin-based dialysis and the use of adsorbents. While the safety of these systems, and their capacity to achieve significant clearance of toxins, has been proven in animal and human studies, the evidence of mortality benefit is yet to be established. This chapter describes currently available liver support systems, their operational characteristics, limitations, evidence of clinical efficacy, and prospects for future development.
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Bangash, M., Agarwal, B., Jalan, R. (2015). Liver Support Systems. In: Keaveny, A., Cárdenas, A. (eds) Complications of Cirrhosis. Springer, Cham. https://doi.org/10.1007/978-3-319-13614-1_26
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DOI: https://doi.org/10.1007/978-3-319-13614-1_26
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