Abstract
In the spring of 2010, two clinical studies that showed no improvement in the mortality of patients suffering from acute-on-chronic liver failure by treatment with liver support systems were presented. The authors of the present article suggest that the reason for the negative results is the inadequate detoxification capacity of the procedures. With the example of the surrogate markers ammonia and bilirubin, the detoxification targets for successful therapy are illustrated. In addition, other necessary functions of liver support systems, including acid-base balance, electrolyte balance, and control of water balance, are defined. The importance of avoiding side effects is particularly stressed, since the positive effects of therapy can be overshadowed. Other open questions deal with the selection of patients, the start of therapy or the issue of intermittent versus continuous therapy. In this context, the current status of bioartificial liver support systems is discussed. © 2010 Springer-Verlag.