Methods of Extracorporeal Liver Support For Treatment of Liver Cell Failure

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Abstract
Acute liver cell failure (ALCF), either fulminant or acute on chronic, is associated to an exceedingly high mortality. Historically, two major types of devices have been conceived based either on mechanical or biological replacement of liver functions. Mechanical models lacked metabolic activity and appeared inefficient for detoxifying the plasma, while Biological models developed for ”global” replacement of liver functions were abandoned because of the development of liver transplantation (LT) that became the treatment of choice. Nowadays, because of organ shortage and because fulminant hepatitis (FH) is potentially reversible, a renewed interest has developed in liver support devices to bridge ALCF patients either to LT or regeneration. These liver support devices were conceived according to two different hypotheses of the cause(s) of liver cell failure: the ”albumin-bound toxin hypothesis” and the ”metabolic support hypothesis”. In this review, we will present the development and progress in extracorporeal liver support systems in the successive decades.

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