Artificial liver support devices

An artificial device able to support liver function might serve as a temporary measure before liver transplantation until a suitable organ becomes available, or until the native liver has regenerated sufficiently such that transplantation may be avoided. Potential options now include:

• Non-biological hepatic assist devices

Non-biological hepatic assist devices are based on plasma exchange, haemodialysis, haemofiltration, charcoal haemoperfusion, and resin haemoperfusion systems. The most widely studied is the molecular adsorbent recirculating system (MARS), but none of these systems has yet to demonstrate a significant impact on clinical end points or overall survival in the setting of acute hepatic failure. (1)

• Bioartificial hepatic assist devices

Bioartificial or cell-based hepatic assist devices incorporate hepatocytes or other cell types to provide metabolic as well as detoxification function as a means of temporary liver support in acute hepatic failure. Cell types used in these devices include immortalised cells such as the C3A human hepatoblastoma cell line or primary porcine hepatocytes but their efficacy in the setting of hepatic failure has yet to be determined. (1)

• Auxiliary transplantation

Auxiliary liver transplantation uses a partial liver allograft to provide temporary support and hepatic function in the setting of acute hepatic failure, allowing the recipient's native liver to recover function. A partial left hepatic lobe or right hepatic lobe is transplanted from the donor to the recipient. This form of transplantation may benefit younger patients, but is associated with a greater incidence of postoperative complications and up to 15% of patients ultimately undergo re-transplantation. (2)

References:

1. Katarey D, Jalan R. Update on extracorporeal liver support. Curr Opin Crit Care. 2020 Apr;26(2):180-5.
2. Liou IW, Larson AM. Role of liver transplantation in acute liver failure. Semin Liver Dis. 2008 May;28(2):201-9.