Artificial liver support in patients with liver failure: a modified DELPHI consensus of international experts
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Artificial liver support in patients with liver failure: a modified DELPHI consensus of international experts. / Saliba, Faouzi; Bañares, Rafael; Larsen, Fin Stolze; Wilmer, Alexander; Parés, Albert; Mitzner, Steffen; Stange, Jan; Fuhrmann, Valentin; Gilg, Stefan; Hassanein, Tarek; Samuel, Didier; Torner, Josep; Jaber, Samir.
In: INTENS CARE MED, Vol. 48, No. 10, 10.2022, p. 1352-1367.Research output: SCORING: Contribution to journal › SCORING: Review article › Research
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TY - JOUR
T1 - Artificial liver support in patients with liver failure: a modified DELPHI consensus of international experts
AU - Saliba, Faouzi
AU - Bañares, Rafael
AU - Larsen, Fin Stolze
AU - Wilmer, Alexander
AU - Parés, Albert
AU - Mitzner, Steffen
AU - Stange, Jan
AU - Fuhrmann, Valentin
AU - Gilg, Stefan
AU - Hassanein, Tarek
AU - Samuel, Didier
AU - Torner, Josep
AU - Jaber, Samir
PY - 2022/10
Y1 - 2022/10
N2 - 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.
AB - 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.
U2 - 10.1007/s00134-022-06802-1
DO - 10.1007/s00134-022-06802-1
M3 - SCORING: Review article
C2 - 36066598
VL - 48
SP - 1352
EP - 1367
JO - INTENS CARE MED
JF - INTENS CARE MED
SN - 0342-4642
IS - 10
ER -