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Extracorporeal Liver Support Systems in Paediatric Liver Failure
1Paediatric Hepatology, Gastroenterology and Nutrition Centre, King's College Hospital, London, UK.
Journal of Pediatric Gastroenterology and Nutrition
|March 2, 2017
Summary
Extracorporeal liver support systems show biochemical effectiveness but lack clear clinical benefits in liver failure. This review critically appraises their efficacy in pediatric liver failure, considering limited data and adult study extrapolation challenges.
Area of Science:
- Hepatology
- Biomedical Engineering
- Critical Care Medicine
Background:
- Extracorporeal liver support systems (ELSS) aim to aid patients with acute liver failure (ALF) and acute-on-chronic liver failure (ACLF).
- These systems serve as a bridge to recovery or liver transplantation, addressing organ donor shortages.
- Despite demonstrated biochemical efficacy, clinical benefits and survival improvements remain unclear, limiting widespread adoption in adult liver failure.
Purpose of the Study:
- To critically review current practices and efficacy of extracorporeal liver support systems in pediatric liver failure.
- To address the scarcity of data and challenges in extrapolating adult study findings to children.
- To inform clinical decision-making regarding the use of ELSS in pediatric patients.
Main Methods:
- Systematic review and critical appraisal of existing literature on ELSS in pediatric liver failure.
- Analysis of studies involving artificial and bioartificial liver devices, including albumin dialysis (e.g., Molecular Adsorbent Recirculating System; MARS) and plasma exchange.
- Consideration of differences in disease presentation, etiology, prognosis, and device suitability/safety in pediatric populations compared to adults.
Main Results:
- Limited data exists on ELSS efficacy in pediatric liver failure, with few reports on albumin dialysis and plasma exchange.
- Adult studies show mixed results, with albumin dialysis lacking clear benefits but plasma exchange showing some potential.
- Extrapolation of adult data to pediatric cases requires careful consideration of age-specific factors.
Conclusions:
- Extracorporeal liver support systems have not achieved widespread acceptance in adult liver failure due to unclear clinical benefits.
- Further research is needed to establish the efficacy and safety of ELSS in pediatric liver failure.
- Tailored approaches and dedicated pediatric studies are essential to determine the true value of these devices in children.
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