Abstract

Acute liver failure (ALF) is a potentially life-threatening condition. Liver support therapies can be applied as a bridging-to-transplantation or bridging-to-recovery; however, results of clinical trials are controversial. Our aim was to compare liver support systems in acute and hyperacute liver failure with network meta-analysis. After systematic search, randomized controlled trials (RCT) comparing liver support therapies in adults with acute or hyperacute liver failure were included. In-hospital mortality was the primary outcome, the secondary outcomes were hepatic encephalopathy and mortality-by-aetiology. A Bayesian-method was used to perform network meta-analysis and calculate surface under the cumulative ranking curve (SUCRA) values to rank interventions. Eleven RCTs were included. BioLogic-DT and molecular adsorbent recirculating system (MARS) resulted in the lowest mortality (SUCRAs: 76% and 73%, respectively). In non-paracetamol-poisoned patients, BioLogic-DT, charcoal hemoperfusion and MARS may be equally efficient regarding mortality (SUCRAs: 53%, 52% and 52%, respectively). Considering hepatic encephalopathy, extracorporeal liver assist device (ELAD) may be the most effective option (SUCRA: 78%). However, in pairwise meta-analysis, there were no statistically significant differences between the interventions in the outcomes. In conclusion, MARS therapy seems to be the best available option in reducing mortality. Further research is needed on currently available and new therapeutic modalities. (CRD42020160133).

Details

Title
Efficacy and safety of liver support devices in acute and hyperacute liver failure: a systematic review and network meta-analysis
Author
Kanjo, Anna 1 ; Klementina, Ocskay 2 ; Gede Noémi 2 ; Kiss Szabolcs 3 ; Szakács Zsolt 4 ; Párniczky Andrea 1 ; Mitzner Steffen 5 ; Stange, Jan 5 ; Hegyi Péter 6 ; Molnár Zsolt 7 

 University of Pécs, Institute for Translational Medicine, Medical School, Pécs, Hungary (GRID:grid.9679.1) (ISNI:0000 0001 0663 9479); Heim Pál National Paediatric Institute, Budapest, Hungary (GRID:grid.9679.1); University of Szeged, Doctoral School of Clinical Medicine, Szeged, Hungary (GRID:grid.9008.1) (ISNI:0000 0001 1016 9625) 
 University of Pécs, Institute for Translational Medicine, Medical School, Pécs, Hungary (GRID:grid.9679.1) (ISNI:0000 0001 0663 9479) 
 University of Pécs, Institute for Translational Medicine, Medical School, Pécs, Hungary (GRID:grid.9679.1) (ISNI:0000 0001 0663 9479); University of Szeged, Doctoral School of Clinical Medicine, Szeged, Hungary (GRID:grid.9008.1) (ISNI:0000 0001 1016 9625) 
 University of Pécs, Institute for Translational Medicine, Medical School, Pécs, Hungary (GRID:grid.9679.1) (ISNI:0000 0001 0663 9479); University of Pécs, János Szentágothai Research Centre, Pécs, Hungary (GRID:grid.9679.1) (ISNI:0000 0001 0663 9479) 
 University of Rostock, Division of Nephrology, Department of Medicine, Rostock, Germany (GRID:grid.10493.3f) (ISNI:0000000121858338) 
 University of Pécs, Institute for Translational Medicine, Medical School, Pécs, Hungary (GRID:grid.9679.1) (ISNI:0000 0001 0663 9479); University of Szeged, Doctoral School of Clinical Medicine, Szeged, Hungary (GRID:grid.9008.1) (ISNI:0000 0001 1016 9625); University of Pécs, János Szentágothai Research Centre, Pécs, Hungary (GRID:grid.9679.1) (ISNI:0000 0001 0663 9479) 
 University of Pécs, Institute for Translational Medicine, Medical School, Pécs, Hungary (GRID:grid.9679.1) (ISNI:0000 0001 0663 9479); University of Szeged, Doctoral School of Clinical Medicine, Szeged, Hungary (GRID:grid.9008.1) (ISNI:0000 0001 1016 9625); Poznan University for Medical Sciences, Medical Faculty, Department of Anesthesiology and Intensive Therapy, Poznan, Poland (GRID:grid.22254.33) (ISNI:0000 0001 2205 0971) 
Publication year
2021
Publication date
2021
Publisher
Nature Publishing Group
e-ISSN
20452322
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2490851512
Copyright
© The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.