Liver replacement therapy with extracorporeal blood purification techniques current knowledge and future directions  

作　　者：Panagiotis Papamichalis Katerina G Oikonomou Asimina Valsamaki Maria Xanthoudaki Periklis Katsiafylloudis Evangelia Papapostolou Apostolia-Lemonia Skoura Michail Papamichalis Marios Karvouniaris Antonios Koutras Eleni Vaitsi Smaragdi Sarchosi Antonios Papadogoulas Dimitrios Papadopoulos 

机构地区：[1]Intensive Care Unit,General Hospital of Larissa,Larissa 41221,Thessaly,Greece [2]Department of Transfusion Medicine,University Hospital of Larissa,Larissa 41110,Thessaly,Greece [3]Department of Cardiology,University Hospital of Larissa,Larissa 41110,Thessaly,Greece [4]Intensive Care Unit,AHEPA University Hospital,Thessaloniki 54636,Greece [5]1^(st) Department of Obstetrics and Gynecology,General Hospital of Athens“ALEXANDRA”,National and Kapodistrian University of Athens,Athens 11528,Greece [6]Department of Anesthesiology,University Hospital of Larissa,Larissa 41110,Thessaly,Greece

出　　处：《World Journal of Clinical Cases》2023年第17期3932-3948,共17页世界临床病例杂志

摘　　要：Clinically,it is highly challenging to promote recovery in patients with acute liver failure(ALF)and acute-on-chronic liver failure(ACLF).Despite recent advances in understanding the underlying mechanisms of ALF and ACLF,standard medical therapy remains the primary therapeutic approach.Liver transplantation(LT)is considered the last option,and in several cases,it is the only intervention that can be lifesaving.Unfortunately,this intervention is limited by organ donation shortage or exclusion criteria such that not all patients in need can receive a transplant.Another option is to restore impaired liver function with artificial extracorporeal blood purification systems.The first such systems were developed at the end of the 20th century,providing solutions as bridging therapy,either for liver recovery or LT.They enhance the elimination of metabolites and substances that accumulate due to compromised liver function.In addition,they aid in clearance of molecules released during acute liver decompensation,which can initiate an excessive inflammatory response in these patients causing hepatic encephalopathy,multiple-organ failure,and other complications of liver failure.As compared to renal replacement therapies,we have been unsuccessful in using artificial extracorporeal blood purification systems to completely replace liver function despite the outstanding technological evolution of these systems.Extracting middle to high-molecular-weight and hydrophobic/protein-bound molecules remains extremely challenging.The majority of the currently available systems include a combination of methods that cleanse different ranges and types of molecules and toxins.Furthermore,conventional methods such as plasma exchange are being re-evaluated,and novel adsorption filters are increasingly being used for liver indications.These strategies are very promising for the treatment of liver failure.Nevertheless,the best method,system,or device has not been developed yet,and its probability of getting developed in the near future is also lo

关 键 词：Liver failure TRANSPLANTATION Blood purification Liver replacement therapy Artificial extracorporeal systems Transplant-free survival 

分 类 号：R575.3[医药卫生—消化系统]