Pediatric Artificial Liver Support Systems in Children with Liver Failure

Current Treatment Options for Pediatric Liver Failure

The American Association for the Study of Liver Diseases recommends urgent liver transplantation as the definitive treatment for pediatric acute liver failure when prognostic indicators suggest a high likelihood of death 1
The American Gastroenterological Association strongly recommends N-acetylcysteine for acetaminophen-induced acute liver failure 2, 3
For non-acetaminophen acute liver failure, N-acetylcysteine should only be used in clinical trial settings, as recommended by the American Gastroenterological Association 3

Multiple systematic reviews have assessed artificial liver support systems for acute liver failure and reported no clear effect on mortality, according to the American Gastroenterological Association 2, 4
Seven randomized controlled trials involving 415 patients with acute liver failure showed no significant improvement in survival with artificial liver support systems, as reported by the American Gastroenterological Association 2, 4, 3
Large RCTs evaluating albumin dialysis (MARS) in Acute-on-Chronic Liver Failure have not demonstrated significant effects on survival, according to the European Association for the Study of the Liver 5

The American Association for the Study of Liver Diseases recommends liver transplantation as life-saving and required for patients with acute liver failure due to Wilson's disease 7
MARS may be used along with plasmapheresis and hemofiltration to stabilize patients and delay, but not eliminate, the need for transplantation, as suggested by the American Association for the Study of Liver Diseases 7

Potential benefits of artificial liver support include bridge to transplantation or recovery, as reported by the American Gastroenterological Association 4, 3
Potential risks include significant resource utilization and high costs, according to the American Gastroenterological Association 2, 3
Potential toxicities including coagulation abnormalities are a concern, as noted by the American Association for the Study of Liver Diseases 1

A post-hoc analysis of the Prometheus study showed potential benefit in patients with MELD scores >30, which warrants further investigation, according to the European Association for the Study of the Liver 5