TY - JOUR
T1 - Role of liver support systems in the management of post hepatectomy liver failure
T2 - a systematic review of the literature
AU - Pufal, Kamil
AU - Lawson, Alexander
AU - Hodson, James
AU - Bangash, Mansoor
AU - Patel, Jaimin
AU - Weston, Chris
AU - Gulik, Thomas van
AU - Dasari, Bobby Vm
PY - 2021/5/31
Y1 - 2021/5/31
N2 - Backgrounds/Aims: Post-hepatectomy liver failure (PHLF) is a serious complication following liver resection, with limited treatment options, and is associated with high mortality. There is a need to evaluate the role of systems that support the function of the liver after PHLF.Aims: The aim of this study was to review the literature and summarize the role of liver support systems (LSS) in the management of PHLF. Publications of interest were identified using systematically designed searches. Following screening, data from the relevant publications was extracted, and pooled where possible.Findings: Systematic review identified nine studies, which used either Plasma Exchange (PE) or Molecular Adsorbent Recirculating System (MARS) as LSS after PHLF. Across all studies, the pooled 90-day mortality rate was 38% (95% CI: 9-70%). However, there was substantial heterogeneity, likely since studies used a variety of definitions for PHLF, and had different selection criteria for patient eligibility for LSS treatment.Conclusions: The current evidence is insufficient to recommend LSS for the routine management of severe PHLF, with the current literature consisting of only a limited number of studies. There is a definite need for larger, multicenter, prospective studies, evaluating the conventional and newer modalities of support systems, with a view to improve the outcomes in this group of patients.
AB - Backgrounds/Aims: Post-hepatectomy liver failure (PHLF) is a serious complication following liver resection, with limited treatment options, and is associated with high mortality. There is a need to evaluate the role of systems that support the function of the liver after PHLF.Aims: The aim of this study was to review the literature and summarize the role of liver support systems (LSS) in the management of PHLF. Publications of interest were identified using systematically designed searches. Following screening, data from the relevant publications was extracted, and pooled where possible.Findings: Systematic review identified nine studies, which used either Plasma Exchange (PE) or Molecular Adsorbent Recirculating System (MARS) as LSS after PHLF. Across all studies, the pooled 90-day mortality rate was 38% (95% CI: 9-70%). However, there was substantial heterogeneity, likely since studies used a variety of definitions for PHLF, and had different selection criteria for patient eligibility for LSS treatment.Conclusions: The current evidence is insufficient to recommend LSS for the routine management of severe PHLF, with the current literature consisting of only a limited number of studies. There is a definite need for larger, multicenter, prospective studies, evaluating the conventional and newer modalities of support systems, with a view to improve the outcomes in this group of patients.
KW - Liver resection
KW - MARS
KW - Plasma exchange system
KW - Post hepatectomy liver failure
UR - http://www.scopus.com/inward/record.url?scp=85115336874&partnerID=8YFLogxK
U2 - 10.14701/ahbps.2021.25.2.171
DO - 10.14701/ahbps.2021.25.2.171
M3 - Review article
C2 - 34053919
SN - 2508-5859
VL - 25
SP - 171
EP - 178
JO - Annals of hepato-biliary-pancreatic surgery
JF - Annals of hepato-biliary-pancreatic surgery
IS - 2
ER -