Extracorporeal liver support a continuing challenge.docVIP

Available online /content/11/1/106 Commentary Extracorporeal liver support: a continuing challenge Ram M Subramanian1 and John A Kellum2 1Departments of Pulmonary Critical Care and Gastroenterology Hepatology, University of Chicago, 5841 South Maryland Ave., MC 6076, Chicago, IL, 60637, USA 2Department of Critical Care Medicine, 608 Scaife Hall, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15261, USA Corresponding author: John A Kellum, kellumja@ Published: 29 January 2007 Critical Care 2007, 11:106 (doi:10.1186/cc5143) This article is online at /content/11/1/106 ? 2007 BioMed Central Ltd See related research by Stadlbauer et al., /content/10/6/R169 Abstract study [4] suggested a decrease in serum cytokine levels following treatment, with an associated improvement in patient prognosis, whereas a second recent study [5] found Given that liver failure continues to pose an enormous clinical challenge, the concept of hepatic dialysis has enjoyed significant interest. In particular, many investigations have examined the therapeutic mechanisms and efficacy of artificial albumin dialysis based systems in acute on chronic liver failure, the results of which have been conflicting. Albumin dialysis systems do not appear to no effect of treatment on cytokines. A crucial factor influencing the outcome of these studies is the severity of liver disease, as measured objectively using the Mayo End Stage Liver Disease score, which may correlate with the ‘cytokine burden’. In the study by Stadlbauer and colleagues included in a previous issue [1], the patient population is characterized by a high degree of disease severity, as evidenced by a mean Mayo End Stage Liver Disease score of 31. Unfortunately, the study demonstrates no efficacy of artificial liver support systems in decreasing cytokine l