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KMID : 1143920210250020171
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Annals of Hepato-Biliary-Pancreatic Surgery
2021 Volume.25 No. 2 p.171 ~ p.178
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Role of liver support systems in the management of post hepatectomy liver failure: A systematic review of the literature
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Pufal Kamil
Lawson Alexander
Hodson James
Bangash Mansoor
Patel Jaimin
Weston Chris
van Gulik Thomas
Dasari Bobby V. M.
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Abstract
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Backgrounds/Aims: Post-hepatectomy liver failure (PHLF) is a serious complication following liver resection, with limited treatment options, and is associated with high mortality. There is a need to evaluate the role of systems that support the function of the liver after PHLF.
Aims: The aim of this study was to review the literature and summarize the role of liver support systems (LSS) in the management of PHLF. Publications of interest were identified using systematically designed searches. Following screening, data from the relevant publications was extracted, and pooled where possible.
Findings: Systematic review identified nine studies, which used either Plasma Exchange (PE) or Molecular Adsorbent Recirculating System (MARS) as LSS after PHLF. Across all studies, the pooled 90-day mortality rate was 38% (95% CI: 9-70%). However, there was substantial heterogeneity, likely since studies used a variety of definitions for PHLF, and had different selection criteria for patient eligibility for LSS treatment.
Conclusions: The current evidence is insufficient to recommend LSS for the routine management of severe PHLF, with the current literature consisting of only a limited number of studies. There is a definite need for larger, multicenter, prospective studies, evaluating the conventional and newer modalities of support systems, with a view to improve the outcomes in this group of patients.
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KEYWORD
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Post hepatectomy liver failure, Liver resection, MARS, Plasma exchange system
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