Extracorporeal Liver Support: Albumin Removal vs. Albumin Regeneration

With the development of clinically successful renal replacement therapies after World War II the idea of extracorporeal liver detoxification gained attractiveness as well. Small metabolites such as ammonia or bilirubin that accumulate during liver failure seemed to represent a group of “liver toxins” worth removing in order to improve the clinical status (Kiley 1956). Since then various techniques have been deployed, including both artificial (i.e. without liver cells or tissue) and bioartificial approaches. Among the artificial systems techniques based on plasma-exchange and plasma-adsorption were studied best. Lack of selectivity and/or efficacy of detoxification appeared as the major shortcoming of the plasma-treatments for liver failure (Mitzner 2002).