Artificial Liver Support Systems

Abstract

Acute liver failure and acute-on-chronic liver failure, regardless of the etiology, generate an inflammatory response in the liver parenchyma and systemic inflammatory response, as well as anti-inflammatory counterregulatory mechanisms that condition a state of immunomodulation, a condition that favors sepsis and septic shock. The increase in Von Willebrand factor and the increase in cellular traffic of monocytes and macrophages in the hepatic sinusoids, altering hepatic hemodynamics, is another mechanism of damage. Artificial liver support therapy represents an alternative in the support of these patients when medical treatment does not achieve the objectives. MARS, Prometheus, and SPAD favor detoxification. Plasma exchange and DPMAS are alternatives to limit the inflammatory response, eliminate Von Willebrand factor, and improve survival. Current evidence recommends the use of plasma exchange or combined extracorporeal support therapies as an alternative to achieve organ recovery or as a bridge to liver transplantation.