Temporary Liver Support : Current Concepts

463 Liver failure occurs either as acute liver failure (ALF) developing de novo or as acute decompensation of chronic liver disease (ACLF). The clinical manifestations are fairly similar characterised by multiorgan dysfunction characterised by encephalopathy (HE), hypotension, and renal failure (HRS).1,2 Unlike chronic decompensation of end-stage liver disease, ALF and ACLF are potentially reversible. A supportive therapy which can tide over the acute period of crisis (and act as a bridge to liver transplantation in cases of ALF) can be possibly life-saving.3 This essential premise of possible reversibility has lead to the attempts over the past 40 years to develop an extracorporeal liver support system. Essentially, two types of liver support systems are under development. (A) Bio-artificial devices, using hepatocytes is based upon the concept that they can perform the functions of the failing liver and (B) Artificial devices, of which the one currently being tried extensively is the Molecular Adsorbents Recirculating System (MARS), utilising the principles of albumin dialysis.