Update on extracorporeal liver support.

PURPOSE OF REVIEW: Extracorporeal liver support (ELS) is a large unmet need in day-to-day hepatology practice. In an era of ever-improving outcomes with liver transplantation for very sick patients with either acute liver failure (ALF) or acute-on-chronic liver failure, the outcomes for similar patients who are ineligible for transplantation remains poor. Providing a bridge to recovery from these catastrophic conditions is the aim of ELS, and we aim to review the evidence to date of different ELS devices as well as look to the future of ELS device development.

RECENT FINDINGS: Studies on different ELS devices shave been relatively consistent in their inability to demonstrate a survival benefit; however, recent published evidence has suggested ways in which the three key pillars to ELS - the disease (patient selection), device (ELS system), and dose (intensity) - may be modified to attain a more positive outcome. New devices are grasping these concepts and demonstrating encouraging preclinical results.

SUMMARY: ELS devices to studied to date have not been able to significantly improve transplant-free survival. Newer ELS devices are currently in clinical trials and their results are awaited.