Molecular adsorbent recirculating system and bioartificial devices for liver failure.

Acute liver failure and acute-on-chronic liver failure remain clinical problems with unacceptable morbidity and mortality. The development of extracorporeal liver support systems that replace the detoxification, synthetic, and regulatory functions of the native liver represent a long-sought potential solution, but all the devices currently available are still far from ideal. In general, artificial (cell-free) and bioartificial liver support devices have shown their ability to decrease some circulating toxins, to ameliorate hepatic encephalopathy and other intermediate variables, and to be relatively safe. Their effects on the survival of patients with ALF or ACLF, however, have not been conclusively shown.