{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T15:08:31Z","timestamp":1793200111664,"version":"4.5.0"},"reference-count":56,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Intensive Care Med"],"abstract":"<jats:p>Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) both have high mortality rates without liver transplantation. Artificial liver support systems may benefit patients with liver failure, serving as a bridge to transplantation or as a destination therapy allowing recovery. There are currently two types of artificial liver support systems: non-biological and biological. Non-biological artificial liver (NBAL) support systems primarily focus on detoxification by removing toxins through selective membranes and adsorbent materials. Well-known NBAL systems are plasma exchange, Molecular Adsorbent Recirculating System (MARS), Single-Pass Albumin Dialysis (SPAD), and the Fractionated Plasma Separation and Adsorption System (Prometheus). NBAL therapies consistently reduce bilirubin and improve encephalopathy; however, pivotal randomized controlled trials such as RELIEF (MARS) and HELIOS (Prometheus) did not confirm a survival advantage, although plasma exchange improved transplant-free survival in acute liver failure. Biological artificial liver (BAL) support systems use human or animal-derived hepatocytes to temporarily replace liver function, including the Extracorporeal Liver Assist Device (ELAD), HepatAssist, and stem-cell-based systems. Early BAL studies showed biochemical and neurological improvements, but large trials such as VTL-308 failed to demonstrate a significant survival benefit over standard medical therapy. Overall, while NBAL and BAL therapies can improve encephalopathy, renal function, and cholestasis, current evidence does not show a clear mortality benefit, and artificial liver support systems remain supportive rather than curative.<\/jats:p>","DOI":"10.1177\/08850666261445379","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T20:40:42Z","timestamp":1777408842000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Artificial Liver Support"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9089-0603","authenticated-orcid":false,"given":"Hyung Kook","family":"Kim","sequence":"first","affiliation":[{"name":"University of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David T.","family":"Huang","sequence":"additional","affiliation":[{"name":"University of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3441-3917","authenticated-orcid":false,"given":"Ali","family":"Al-Khafaji","sequence":"additional","affiliation":[{"name":"University of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(93)91818-7"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1301733"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.09.011"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2016.03.046"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60274-7"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1914900"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00309-8"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2015.219"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30056"},{"key":"e_1_3_2_11_2","first-page":"1027152","article-title":"Systemic inflammation and acute-on-chronic liver failure: Too much, not enough","author":"Laleman W","year":"2018","unstructured":"Laleman W, Cl\u00e0ria J, Van der Merwe S, et al. 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