People with liver failure may in future be able to recover by being hooked up to dialysis equipment to clean their blood of toxins.
The idea is akin to kidney dialysis, when people with kidney failure regularly go to a clinic or hospital to have their blood cleaned of the waste products normally removed by the kidneys.
The liver performs more complex functions, which until now couldn鈥檛 be mimicked. But a new technique has shown promise in a small clinical trial where it boosted the recovery process from liver failure.
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Liver failure can be triggered by infections, drug overdoses or a worsening of long-term conditions such as cirrhosis, scarring of the liver that can be caused by drinking too much alcohol.
One of the liver鈥檚 main functions is to remove harmful compounds from the blood that come from food and drink or are made when the body processes food. In severe liver failure, there is a build-up of toxins, which can lead to damage to other organs and death.
If the liver鈥檚 detoxifying role could be temporarily replaced by dialysis, it would help people to recover because livers can naturally regenerate, says at the Royal Free Hospital in London. In people with permanent liver damage, dialysis could keep them alive until they get a transplant.
Many toxins from food and drink are transported in the blood while bound to albumin, a protein made by the liver. Initial attempts to replace the liver鈥檚 function have involved simple forms of dialysis, where the blood is passed through a filter containing clean albumin, unbound to toxins.
The idea is that toxins pass from the albumin in the blood to the clean albumin. This treatment is on offer in certain hospitals around the world, but some trials have failed to show it does any good and the UK鈥檚 National Institute for Health and Clinical Excellence has concluded there .
That is because people with liver failure don鈥檛 make enough albumin and what little there is doesn鈥檛 function properly, says Agarwal. 鈥淲hatever albumin is being produced is of low quality.鈥�
So Agarwal and his colleagues developed a different approach, removing the toxin-bound albumin from the individual鈥檚 blood and replacing it with an infusion of fresh albumin. A second filter removes the toxins made by the person鈥檚 body that aren鈥檛 bound to albumin.
The technique was tested in 30听people in intensive care with liver failure caused by a flare-up of alcoholic cirrhosis, using a machine called Dialive made by a UK firm called , which has commercialised the approach. Half the group had three to five dialysis sessions, while the rest got usual care.
Ten out of the 15 people who got dialysis recovered from their flare-up after 10 days, compared with five out of the 15 who got usual care. The results were presented at the , which was held virtually.
The work is at an early stage, but the results are promising, says Tobias B枚ttler at the University of Freiburg in Germany, who wasn鈥檛 involved in the trial. 鈥淲e are really desperate to find something to bridge to transplantation,鈥� he says.
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