Artificial Hepatic Support

The advent of successful orthotopic liver transplantation for patients with both acute and chronic liver failure has been a major breakthrough in clinical practice, for patients who would have otherwise died [1]. Patients with chronic liver disease are now listed for transplantation well before terminal liver failure, and therefore can potentially wait for a suitable donor liver. However, those with acute hepatic failure [2] can be desperately ill, and may require urgent transplantation. Unfortunately, the number of patients with liver disease awaiting transplantation now exceeds the donation rate. If no liver is immediately available, and the clinical condition of the patient is deteriorating, then the question of artificial liver support arises. Similarly, some patients will have contraindications to transplantation, due to cardiovascular or intracranial instability, sepsis or psychosocial factors [3]. In these cases artificial liver support may help, and so allow subsequent transplantation. Patients with chronic liver disease may develop encephalopathy and hepatorenal syndrome [4] secondary to acute events including sepsis and gastrointestinal hemorrhage. Artificial liver support may help to quicken recovery from such acute events. Over the years several treatments have been advocated to improve survival in both patients with acute and chronic liver failure. After initial success reported in small selected series, many have not then been substantiated in larger randomized controlled trials. Dialysis