Liver Dialysis

Liver dialysis is a detoxification treatment for liver failure and decompensated liver. It is similar to hemodialysis and based on the same principles. Like a bioartificial liver device, it is a form of artificial extracorporeal liver support. A critical issue of the clinical syndrome in liver failure is the accumulation of toxins not cleared by the failing liver. The removal of lipophilic, albumin-bound substances such as bilirubin, bile acids, and metabolites of aromatic amino acids, medium-chain fatty acids and cytokines should be beneficial to the clinical course of a patient in liver failure.

Liver dialysis is a process which removes toxins from the liver in order to sustain patients until a liver transplant can be done. Liver dialysis is considered a very temporary solution for transition to liver transplant. The act of liver filtration can be effective at removing toxins from the liver for several weeks to a few months, taking some of the strain off the ailing organ.

Liver Disorders
Liver disorders may be a consequence of any type of liver disease, including viral hepatitis, cirrhosis, and liver damage from alcohol or drugs. Without treatment, a person with liver disease is susceptible to a wide range of complications, including:
  • Hepatic encephalopathy - scar tissue prevents adequate blood flow through the liver, preventing clearance of toxins. Circulating toxins may affect brain functioning, leading to coma.
  • Ascites - a build-up of sodium, which leads to fluid retention in the abdominal cavity and in the legs, feet and back (edema).
  • Liver failure - liver cells are destroyed faster than replacement rate, until the organ can no longer function.
  • Cancer - chronic cirrhosis or some forms of hepatitis can make the liver more susceptible to primary cancer.
A large portion of the liver must be damaged before liver failure occurs. Liver failure may develop rapidly (days or weeks) or gradually (months or years), possibly progressing to multi-organ failure and death.
The primary role of an artificial liver support device is the removal of toxins from the blood. Early extracorporeal devices for artificial liver support have used procedures such as hemodialysis, hemofiltration, plasma exchange and hemoperfusion using charcoal or polymer-based sorbents. These procedures were not effective in their ability to remove albumin-bound toxic molecules and have demonstrated adverse side effects.
The success of the procedure depends on a number of factors. Please discuss the likelihood of success with your doctor before the procedure.
What if this procedure is not performed?
For intermittent hepatic support for the patients with end-stage liver disease, intracranial pressure increase is the critical event in the evolution of fulminant hepatic failure encephalopathy. When brain edema and intracranial pressure develop, the therapeutic window decreases. Small adjustments of blood volume may affect intracranial pressure, with no connection with any beneficial effect of artificial hepatic support. Actual artificial hepatic supports cannot be a complete solution for the complex disorders leading to hepatic failure. They can achieve the clearance of toxins but cannot substitute the hepatic synthesis and recovery functions.

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