Extra-Corporeal Systems in Acute Liver Failure: Quickfire videos from the ILTS Acute Liver Failure SIG

Speakers: Akila Rajakumar, Dr Rela Institute & Medical Centre, Chennai, India. Florent Artru, Clinical Research Fellow - King's College Hospital, London, UK

Florent Artru: Hello, I'm Florent Artru from King's College Hospital London. On behalf of the ILTS Acute Liver Failure Special Interest Group Steering Committee, it's my pleasure to introduce this short video focusing on an emerging field in the management of acute liver failure, which is the use of extracorporeal systems. According to a large international survey launched last year, we have observed a wide heterogeneity of use of these devices worldwide ranging from 20% in Latin America to almost 90 to 100% in Australia and New Zealand. And this, despite emerging evidences regarding the potential benefit of ECLS in the field of acute liver failure, three experts from our group have summarized their opinion for and against the use of the ECLS. We hope that this video will encourage you to better explore the field and eventually participate in future research projects eventually participate in future research projects. Do not hesitate to interact on social media with this video and also with our group.

Akila Rajakumar: Hello everybody. I'm Akila, from India. When it comes to acute liver failure management from our part of the world, we're no different from the western world in terms of overall survival or survival with liver transplant. But what is different is the etiology. 60 to 90% of our patients with acute liver failure are due to viral hepatitis. Now we have only two important ECLS interventions which have shown survival benefit in acute liver failure. One is high volume plasma exchange from the European centers and the second one is MARS® from US-ALF study group. Now, when you look carefully at the study population from both studies, half of them are due to acetaminophen poisoning. Can the results from those studies be extrapolated to our population? - is a question which we need to address. There are two other important factors: One is a very, very limited deceased donor organ availability in our part of the world. 85% of the transplants that we perform are living donor liver transplants, and economic resources are also limited: cost is a very important factor. Therefore, for any new intervention to be applicable here, we need to have robust scientific evidence. What additional benefits are they going to offer in addition to this well proven and established standard medical therapy? Do they confer any form of additional harm? Mars® can be prohibitively expensive for our country. Very important concerns accepts this: we have problems with antibiotic prescription practices which are not monitored. The health care practices are not uniform, structured, and standardized across the country, as we see in the western world. Approximately 50% of patients who come for transplants are already colonized with CRE bacteria. So that is a problem and it can be a bigger problem in the institute of high volume plasma exchange: because it involves non selective removal of both pro- and anti-inflammatory cytokines. Hence, it can also be removing your antibacterial and antifungal, which can interfere with liver regeneration and also enhances the susceptibility of these patients to sepsis.