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Intensive Care Medicine
Published in: Intensive Care Medicine 10/2022

06-09-2022 | Hepatic Encephalopathy | Narrative Review

Artificial liver support in patients with liver failure: a modified DELPHI consensus of international experts

Authors: Faouzi Saliba, Rafael Bañares, Fin Stolze Larsen, Alexander Wilmer, Albert Parés, Steffen Mitzner, Jan Stange, Valentin Fuhrmann, Stefan Gilg, Tarek Hassanein, Didier Samuel, Josep Torner, Samir Jaber

Published in: Intensive Care Medicine | Issue 10/2022

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Abstract

The present narrative review on albumin dialysis provides evidence-based and expert opinion guidelines for clinicians caring for adult patients with different types of liver failure. The review was prepared by an expert panel of 13 members with liver and ntensive care expertise in extracorporeal liver support therapies for the management of patients with liver failure. The coordinating committee developed the questions according to their importance in the management of patients with liver failure. For each indication, experts conducted a comprehensive review of the literature aiming to identify the best available evidence and assessed the quality of evidence based on the literature and their experience. Summary statements and expert’s recommendations covered all indications of albumin dialysis therapy in patients with liver failure, timing and intensity of treatment, efficacy, technical issues related to the device and safety. The panel supports the data from the literature that albumin dialysis showed a beneficial effect on hepatic encephalopathy, refractory pruritus, renal function, reduction of cholestasis and jaundice. However, the trials lacked to show a clear beneficial effect on overall survival. A short-term survival benefit at 15 and 21 days respectively in acute and acute-on-chronic liver failure has been reported in recent studies. The technique should be limited to patients with a transplant project, to centers experienced in the management of advanced liver disease. The use of extracorporeal albumin dialysis could be beneficial in selected patients with advanced liver diseases listed for transplant or with a transplant project. Waiting future large randomized controlled trials, this panel experts’ statements may help careful patient selection and better treatment modalities.
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Metadata
Title
Artificial liver support in patients with liver failure: a modified DELPHI consensus of international experts
Authors
Faouzi Saliba
Rafael Bañares
Fin Stolze Larsen
Alexander Wilmer
Albert Parés
Steffen Mitzner
Jan Stange
Valentin Fuhrmann
Stefan Gilg
Tarek Hassanein
Didier Samuel
Josep Torner
Samir Jaber
Publication date
06-09-2022
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 10/2022
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-022-06802-1

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