Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, UK.
Curr Opin Crit Care. 2020 Apr;26(2):180-185. doi: 10.1097/MCC.0000000000000708.
Extracorporeal liver support (ELS) is a large unmet need in day-to-day hepatology practice. In an era of ever-improving outcomes with liver transplantation for very sick patients with either acute liver failure (ALF) or acute-on-chronic liver failure, the outcomes for similar patients who are ineligible for transplantation remains poor. Providing a bridge to recovery from these catastrophic conditions is the aim of ELS, and we aim to review the evidence to date of different ELS devices as well as look to the future of ELS device development.
Studies on different ELS devices shave been relatively consistent in their inability to demonstrate a survival benefit; however, recent published evidence has suggested ways in which the three key pillars to ELS - the disease (patient selection), device (ELS system), and dose (intensity) - may be modified to attain a more positive outcome. New devices are grasping these concepts and demonstrating encouraging preclinical results.
ELS devices to studied to date have not been able to significantly improve transplant-free survival. Newer ELS devices are currently in clinical trials and their results are awaited.
体外肝支持（ELS）是日常肝脏病学实践中的一个巨大未满足需求。在肝移植治疗急性肝衰竭（ALF）或慢加急性肝衰竭等非常严重的患者方面，疗效不断提高的时代，对于不符合移植条件的类似患者，其结局仍然较差。ELS 的目的是为这些灾难性疾病提供恢复的桥梁，我们旨在回顾迄今为止不同 ELS 设备的证据，并展望 ELS 设备开发的未来。
不同 ELS 设备的研究在其无法证明生存获益方面相对一致；然而，最近发表的证据表明，ELS 的三个关键支柱——疾病（患者选择）、设备（ELS 系统）和剂量（强度）——可以进行修改，以获得更积极的结果。新型设备正在掌握这些概念，并展示出令人鼓舞的临床前结果。
迄今为止研究的 ELS 设备未能显著提高无移植生存率。目前正在进行临床试验的新型 ELS 设备，我们正在等待其结果。
