Advances in Extracorporeal Liver Support

Extracorporeal liver support (ECLS) systems provide detoxification and synthetic function support for patients with acute liver failure and acute-on-chronic liver failure to achieve spontaneous recovery of hepatic function or act as a bridge to liver transplant. Artificial ECLS (A-ECLS) systems use diffusion, convection, and adsorption to remove toxins and modulate inflammation, improving biochemical and hemodynamic parameters. Despite the development of multiple A-ECLS devices, only plasma exchange has demonstrated a survival benefit in acute liver failure, while other devices require further study. Studies in bioartificial ECLS (B-ECLS) systems have utilized human or porcine hepatocytes in the extracorporeal circuit to serve the hepatic functions of both detoxification and synthetic function, but there is insufficient evidence to support their use currently. Future studies should prioritize evaluating combination strategies that integrate A-ECLS and B-ECLS systems and should define efficacy by expanding study endpoints beyond traditional transplant-free survival endpoints to include both overall survival and transplant-related outcomes. In conclusion, current and future advances in ECLS may provide valuable therapeutic options in the management of patients with liver failure.