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Plasmapheresis and extracorporeal liver support

    Roger Williams

    Roger Williams is Director of the Institute of Hepatology (London, UK) and of the Foundation for Liver Research. Before that, he had established, over a period of 30 years, the world-renowned Institute of Liver Studies at King’s College Hospital (London, UK). He is a Fellow of the Academy of Medical Sciences and is the recipient of numerous honorary fellowships, medals and prizes, including the American Society of Transplantation Senior Achievement Award in 2004, a Hans Popper Lifetime Achievement Award in 2008 and in 2011 the Distinguished Service Award of the International Liver Transplant Society. His main clinical and research interests are in acute liver failure, liver transplantation, complications of cirrhosis and management of viral hepatitis.

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    &
    Julia Wendon

    Julia Wendon trained in internal medicine before specializing in liver intensive care and hepatology, and has been a consultant within the Institute of Liver Studies, King’s College Hospital (London, UK) since 1992. Her focus is in liver intensive care incorporating encephalopathy, hepatorenal failure, haemodynamic failure, sepsis and immune function, liver support systems, liver function assessment and management of acute liver failure.

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    Published Online:13 Feb 2013https://doi.org/10.2217/ebo.12.374
    Abstract:

    This chapter will cover the two main types of extracorporeal device for temporary liver support based on adsorbents and dialysis plus additional biological cell module in the bioartificial devices. The nature of ‘plasma toxemia’ in acute liver failure and the rationale for temporary liver support will also be discussed, along with the results of controlled clinical trials of the current devices MARS™ and Prometheus™ in acute liver failure and acute-on-chronic liver failure. The chapter concludes with a look at the implications of reduced albumin binding capacity for toxins in advanced liver disease in the context of temporary liver support.

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