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liver replacement therapy with extracorporeal blood purification techniques current knowledge and future directions

World Journal of Clinical Cases 2023年第17期11卷 3932-3948页

作者： Panagiotis Papamichalis Katerina G Oikonomou Asimina Valsamaki Maria Xanthoudaki Periklis Katsiafylloudis Evangelia Papapostolou Apostolia-Lemonia Skoura Michail Papamichalis Marios Karvouniaris Antonios Koutras Eleni Vaitsi Smaragdi Sarchosi Antonios Papadogoulas Dimitrios Papadopoulos Intensive Care Unit General Hospital of LarissaLarissa 41221ThessalyGreece Department of Transfusion Medicine University Hospital of LarissaLarissa 41110ThessalyGreece Department of Cardiology University Hospital of LarissaLarissa 41110ThessalyGreece Intensive Care Unit AHEPA University HospitalThessaloniki 54636Greece 1^(st) Department of Obstetrics and Gynecology General Hospital of Athens“ALEXANDRA”National and Kapodistrian University of AthensAthens 11528Greece Department of Anesthesiology University Hospital of LarissaLarissa 41110ThessalyGreece

Clinically,it is highly challenging to promote recovery in patients with acute liver failure(ALF)and acute-on-chronic liver failure(ACLF).Despite recent advances in understanding the underlying mechanisms of ALF and ACLF,standard medical therapy remains the primary therapeutic approach.liver transplantation(LT)is considered the last option,and in several cases,it is the only intervention that can be lifesaving.Unfortunately,this intervention is limited by organ donation shortage or exclusion criteria such that not all patients in need can receive a transplant.Another option is to restore impaired liver function with artificial extracorporeal blood purification systems.The first such systems were developed at the end of the 20th century,providing solutions as bridging therapy,either for liver recovery or LT.They enhance the elimination of metabolites and substances that accumulate due to compromised liver function.In addition,they aid in clearance of molecules released during acute liver decompensation,which can initiate an excessive inflammatory response in these patients causing hepatic encephalopathy,multiple-organ failure,and other complications of liver failure.As compared to renal replacement therapies,we have been unsuccessful in using artificial extracorporeal blood purification systems to completely replace liver function despite the outstanding technological evolution of these systems.Extracting middle to high-molecular-weight and hydrophobic/protein-bound molecules remains extremely challenging.The majority of the currently available systems include a combination of methods that cleanse different ranges and types of molecules and toxins.Furthermore,conventional methods such as plasma exchange are being re-evaluated,and novel adsorption filters are increasingly being used for liver indications.These strategies are very promising for the treatment of liver failure.Nevertheless,the best method,system,or device has not been developed yet,and its probability of getting developed in the near future is also lo

关键词： liver failure Transplantation Blood purification liver replacement therapy Artificial extracorporeal systems Transplant-free survival

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