Artificial Liver Support Systems.

BACKGROUND AND AIM Artificial liver systems are used to bridge between transplantation or to allow a patient's liver to recover. They are used in patients with acute liver failure (ALF) and acute-on-chronic liver failure (ACLF). There are five artificial systems currently in use; molecular adsorbent recirculating system (MARS), single-pass albumin dialysis (SPAD), Prometheus, selective plasma filtration therapy (SEPET) and hemodiafiltration. The aim is to compare existing data on the efficiency of these devices. METHODS A literature search was conducted using online libraries. Inclusion criteria included randomised control trials or comparative human studies published after the year 2000. A systematic review was conducted for the five individual devices with a more detailed comparison of the biochemistry for the SPAD and MARS systems. RESULTS 89 patients were involved in the review comparing SPAD and MARS. Results showed that there was an average reduction in bilirubin (-53μmol/L in MARS and -50μmol/L in SPAD), creatinine (-19.5μmol/L in MARS and -7.5μmol/L in SPAD), urea (-0.9mmol/L in MARS and -0.75mmol/L in SPAD) and GGT (-0.215μmol/L.s in MARS and -0.295μmol/L.s in SPAD) in both SPAD and MARS. However, there was no significant difference between the changes in the two systems. CONCLUSIONS This review demonstrated that both MARS and SPAD aid recovery of ALF. There is no difference between the efficiency of MARS and SPAD. Due to the limited data, there is a need for more randomised control trials. Evaluating cost and patient preference would aid in differentiating the systems.