Abstract
Despite existing procedures to replace lung or renal function in everyday clinical routine, an equivalent method to replace liver function is still missing to bridge patients to regenerate liver function or until transplantation. At the moment, neither the patient groups who would profit from such therapies nor the characteristics of the liver replacement therapy itself seem to be clear. Evaluation of the most important systemic parameters like blood flow, anticoagulation, and influence on biocompatibility are missing. Currently there are three main types of liver support systems: (1) plasmapheresis, e.g., SEPET® (Arbios); (2) artificial detoxification systems, e.g., albumin dialysis (MARS® (Gambro) or SPAD), and Prometheus® (Fresenius); (3) bioartificial detoxification systems where hepatocytes are used in bioreactors to compensate for liver function. Based on the current literature, the commonly used systems, especially with regard to detoxification, seem to be useful in the treatment of patients with hepatic encephalopathy. At present, there is no evidence that treatment with the commercially available liver support systems can improve survival in patients with liver failure. Two large multi-center studies are being performed for MARS (Relief II) and Prometheus (Helios), which will hopefully answer these questions. © Springer-Verlag 2009.