Table 3.
Artificial liver support devices.
| (A) Non–Albumin-Based Devices | |
| Method | Brief Explanation |
| Hemodialysis | In 1958 Kiley et al. described the symptomatic and clinical improvement in form of improved neurological status in four of the five patients of ammonia intoxication treated by hemodialysis. However, no benefit was noted in long-term survival of these patients. |
| Charcoal hemoperfusion | Initially used in the treatment of barbiturate poisoning, charcoal hemoperfusion has been shown to remove many water-soluble molecules associated with encephalopathy in hepatic failure patients. |
| Hemodi-absorption | This is a procedure that has the capability of removing toxins of less than 5 kDa. These include aromatic amino acids, glutamine, mercaptans, benzodiazepine-like substances, false neural transmitters, ammonia, and manganese. |
| Plasma exchange TPE (Therapeutic Plasma Exchange) HVP (High Volume Plasma exchange) | Plasma element is separated from cellular blood components of blood by using a hollow fiber filter made of cellulose diacetate and polyethylene membrane or other synthetic materials. |
| Hemodiafiltration | This is a combination of hemodialysis and hemofiltration. Hemodialysis is useful for removing molecules which are less than 5 kDa and hemofiltration can remove molecules in the 5–10 kDa range. A high-performance membrane such as a large-pore sized poly methyl methacrylate (PMMA) membrane is performed. |
| (B) Albumin-based systems | |
| Company | Brief explanation |
| MARS® (molecular adsorbent recirculating system) | Uses a high-flux hollow-fiber hemodiafilter and albumin as the acceptor molecule for albumin-bound toxins within the extracorporeal circuit |
| Prometheus | Based on an albumin-permeable polysulfone membrane, which enables the patient’s albumin fraction to pass into a secondary circuit in which the direct purification from albumin-bound toxins by different absorbers (that is, anion exchanger and neutral resin) takes place. |
| SPAD (single-pass albumin dialysis) | It uses a standard continuous renal replacement therapy system without any additional columns or circuits. Blood is dialyzed against a standard dialysis solution with the addition of 4.4% albumin in the dialysate. |
| SEPET (selective plasma filtration therapy) | Combines aspects of fractionated plasma separation, adsorption and single-pass albumin dialysis. The fractionated plasma passes through an albumin-permeable size-selective membrane. |
| BioLogic-DT (later Liver Dialysis System™ [HemoCleanse, Lafayette, IN, USA]) | Based on a cellulosic plate dialyzer with a suspension of powdered charcoal and cation exchangers as dialysates, is no longer marketed. |