Southern California Liver Centers, Coronado, California, USA.
Curr Opin Crit Care. 2011 Apr;17(2):195-203. doi: 10.1097/MCC.0b013e328344b3aa.
Acute-on-chronic liver failure (ACLF), a syndrome precipitated by acute liver injury in patients with advanced cirrhosis, is associated with multiorgan dysfunction and high rates of mortality. Liver support systems have been developed in an attempt to improve survival of patients with ACLF by providing a bridge until recovery of the native liver function.
Nonbiological devices such as molecular adsorbent recirculating system (MARS) and fractionated plasma separation and adsorption (Prometheus) are effective in improving severe hepatic encephalopathy and cholestasis, have good safety and tolerability profiles and are frequently employed in patients with ACLD; however, randomized controlled trials (RCTs) failed to show improvement in survival. Biologic devices that incorporate hepatic cells in bioreactors are also under development. Recent data from pilot studies suggested improvement in survival rates in some groups of patients with ACLF; however, their effect on patient survival in RCT is still unknown.
Liver support systems are safe and well tolerated when used in management of patients with ACLF. Their use should continue in controlled clinical trials to explore their role in bridging patients to liver transplantation or recovery in well defined patient groups.
急性慢性肝衰竭（ACLF）是由肝硬化患者的急性肝损伤引起的综合征，伴有多器官功能障碍和高死亡率。已经开发了肝支持系统，试图通过提供恢复天然肝功能的桥梁来提高 ACLF 患者的生存率。
非生物设备，如分子吸附再循环系统（MARS）和分级血浆分离和吸附（Prometheus），在改善严重肝性脑病和胆汁淤积方面是有效的，具有良好的安全性和耐受性，并且经常用于 ACLD 患者；然而，随机对照试验（RCT）未能显示生存率的提高。将肝细胞纳入生物反应器的生物设备也在开发中。最近的试点研究数据表明，某些 ACLF 患者群体的生存率有所提高；然而，它们对 RCT 中患者生存的影响尚不清楚。
肝支持系统在 ACLF 患者的治疗中是安全且耐受良好的。它们的使用应继续在对照临床试验中进行，以探索它们在桥接患者进行肝移植或在明确界定的患者群体中恢复方面的作用。
