Renal Replacement Therapy Combined with Artificial or Bioartificial Liver Support System

Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) are critical conditions associated with high mortality rates ranging from 25% to 50%. Despite medical interventions, ALF frequently leads to patient demise while awaiting transplantation. The imperative for a liver support system emerges as a crucial interim measure, acting as a “bridge” to final treatment or until the liver regenerates postremoval of the triggering factor. While numerous artificial liver support systems have been developed, their efficacy in reducing mortality among ALF patients remains contentious. The prospect of an implantable liver system, facilitating hepatocyte culture on substrates to mimic the liver’s lobular structure, holds promise, albeit clinical availability remains pending. While the realization of this intricate technology awaits, various extracorporeal purification techniques (such as continuous renal replacement therapy (CRRT), intermittent renal replacement therapy (IRRT), hemoperfusion (HP), and hemoadsorption) offer a viable approach to providing multiorgan support, enabling renal and hepatic purification. The objective of this chapter is to elucidate the challenges inherent in managing acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) while emphasizing the critical need for effective interim treatments to mitigate mortality rates. It aims to explore the current landscape of artificial liver support systems, discuss the potential of emerging implantable liver technologies, and underscore the role of extracorporeal purification techniques in providing essential multiorgan support for patients suffering from ALF and ACLF.