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Liver support systems for adults with acute liver failure
Arturo J Martí-Carvajal1,2, Buddheera Bandara Wm Kumburegama3,4, Dimitrinka Nikolova3,4
1Cátedra Rectoral de Medicina Basada en la Evidencia, Universidad de Carabobo, Valencia, Venezuela.
Liver support systems show uncertain effects on mortality and other outcomes for acute liver failure (ALF). More research is needed to clarify benefits and harms of these systems in ALF patients.
Area of Science:
- Hepatology
- Critical Care Medicine
- Medical Technology
Background:
- Acute liver failure (ALF) is a critical condition with high mortality.
- Liver support systems aim to bridge patients to recovery or transplantation.
- Previous randomized clinical trials (RCTs) yielded conflicting results regarding their efficacy.
Purpose of the Study:
- To evaluate the benefits and harms of liver support systems combined with standard medical care versus standard care alone for adults with ALF.
- To synthesize evidence from RCTs on the effectiveness of liver support systems in ALF.
Main Methods:
- Systematic review and meta-analysis of parallel-group RCTs.
- Searched multiple databases including Cochrane, MEDLINE, and Embase up to July 2025.
- Included 11 RCTs with 681 participants comparing liver support systems with standard care.
Main Results:
- Evidence certainty was very low for all outcomes due to risk of bias and imprecision.
- Liver support systems showed little to no effect on all-cause mortality (by day 28 and maximal follow-up), serious adverse events, and liver transplantation.
- Evidence regarding hepatic encephalopathy and multi-organ failure remains highly uncertain.
Conclusions:
- Current evidence is insufficient to determine the effects of liver support systems on mortality, transplantation, or other critical outcomes in ALF.
- There is a lack of data on health-related quality of life.
- Further high-quality research is needed to guide clinical practice.
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