Trials and tribulations with artificial liver support.

This paper reviews the experience gained over the past few years in two techniques of liver support, charcoal haemoperfusion and polyacrylonitrile membrane haemodialysis. Problems with charcoal haemoperfusion have centred around platelet aggregation and hypertension, and new carbon preparations with a variety of different coatings to overcome these problems are described. Haemodialysis using the PAN membrane has caused fewer side-effects and current results show that 33% of patients so treated recover consciousness. The new techniques for liver support currently being developed, including combined dialysis/perfusion systems and those based on plasma separation, are also described.