Role of liver support systems in the management of post hepatectomy liver failure: A systematic review of the literature

Abstract

Backgrounds/Aims: Post-hepatectomy liver failure (PHLF) is a serious complication following liver resection, with limited treatment options, and is associated with high mortality. There is a need to evaluate the role of systems that support the function of the liver after PHLF. Aims: The aim of this study was to review the literature and summarize the role of liver support systems (LSS) in the management of PHLF. Publications of interest were identified using systematically designed searches. Following screening, data from the relevant publications was extracted, and pooled where possible. Findings: Systematic review identified nine studies, which used either Plasma Exchange (PE) or Molecular Adsorbent Recirculating System (MARS) as LSS after PHLF. Across all studies, the pooled 90-day mortality rate was 38% (95% CI: 9-70%). However, there was substantial heterogeneity, likely since studies used a variety of definitions for PHLF, and had different selection criteria for patient eligibility for LSS treatment. Conclusions: The current evidence is insufficient to recommend LSS for the routine management of severe PHLF, with the current literature consisting of only a limited number of studies. There is a definite need for larger, multicenter, prospective studies, evaluating the conventional and newer modalities of support systems, with a view to improve the outcomes in this group of patients.

Perioperative screening and management in elective complex hepatobiliary surgery

“…Liver support systems can serve as a bridge to recovery of liver function in the remnant liver. Various reviews on the role of extracorporeal support systems and plasma exchange conclude that evidence is insufficient to recommend their routine use [46 ▪▪ ,50 ▪ ]. Irreversible PHLF can only be salvaged with a liver transplant.…”

“…Irreversible PHLF can only be salvaged with a liver transplant. Theoretically auxiliary liver transplant (APOLT) is a good option as it can support until the native remnant liver regenerates [46 ▪▪ ,50 ▪ ].…”

Liver-Support Therapies in Critical Illness—A Comparative Analysis of Procedural Characteristics and Safety

“…Recently, TPE has been shown to improve outcomes in patients with ALF by increasing transplant-free survival [17]. However, the overall evidence is still limited, and especially the role of TPE for other etiologies of liver dysfunction such as post-hepatectomy-associated liver failure or hypoxic liver failure in patients with ALD remains elusive [9,25]. Lastly, the extracorporeal blood purification device CytoSorb-initially developed for removing inflammatory mediators and cytokines in septic shock-is now suggested as a new treatment strategy in patients with liver dysfunction, since it adsorbs hydrophobic molecules of up to 55 kilo Daltons (kDa) in size and can be combined with standard RRT techniques [26][27][28][29][30].…”

Albumin‐bilirubin score is superior to platelet‐albumin‐bilirubin score and model for end‐state liver disease sodium for predicting posthepatectomy liver failure

“…The severity of PHLF range from biochemical lab abnormalities that do not change the postoperative clinical course to multiorgan system failure requiring intensive care 2 . Patients with severe PHLF have a postoperative mortality rate as high as 50% 2,3 . Therefore, it is important to risk stratify patients for the risk of PHLF in the perioperative management of patients who require hepatic resection.…”

“…2 Patients with severe PHLF have a postoperative mortality rate as high as 50%. 2,3 Therefore, it is important to risk stratify patients for the risk of PHLF in the perioperative management of patients who require hepatic resection.…”