Knowledge Portal
Extracorporeal liver support and RRT
Extracorporeal therapies in liver failure serve different purposes and should not be grouped together as ‘liver dialysis’. Conventional RRT treats standard renal indications and may help control severe hyperammonaemia, but it does not replace hepatic synthetic or immune function. Albumin dialysis systems, adsorption devices and therapeutic plasma exchange remove different circulating substances and have different evidence in acute liver failure and ACLF. Their use should be tied to a defined goal such as bridge to recovery or transplantation, with explicit review of benefit, complications and stopping criteria.
Key information
Guidelines and position statements
Relevant clinical practice guidelines, practice guidance, consensus statements and position papers from professional bodies and expert groups.
EASL Clinical Practice Guidelines on acute-on-chronic liver failure
EASL · guideline · 2023
Places artificial liver support within the broader evidence and recommendations for organ support in ACLF.
Open resource →Further context
Other useful resources
Selected review articles, practical explainers, expert discussions, reference sites and e-learning from established providers.
Advances in extracorporeal liver support for acute and acute-on-chronic liver failure
Toapanta-Gaibor D, et al. Medicina Intensiva (English Edition). 2025;49(11):502291.
A current overview of albumin dialysis, adsorption systems, plasma exchange and the uncertainty around outcome benefit.
Open resource →Therapeutic Plasma Exchange in Hepatology: Indications, Techniques, and Practical Application
Agrawal D, Ariga KK, Gupta S, Saigal S. Journal of Clinical and Experimental Hepatology. 2025;15(1):102410.
A practical open-access review of technique, replacement fluid, complications and liver-specific indications.
Open resource →Renal Replacement Therapy in Cirrhosis: A Contemporary Review
Pelusio C, Endres P, Neyra JA, Allegretti AS. Advances in Kidney Disease and Health. 2024;31(2):133–138.
A concise guide to modality, timing, prognosis and transplant-related decision-making when cirrhosis and kidney failure coexist.
Open resource →Why would we consider plasma exchange in acute liver failure?
AASLD Liver Fellow Network · clinical explainer · 2024
A clear explanation of the biological rationale and the key high-volume plasma-exchange evidence.
Open resource →RELIEF
Critical Care Reviews · landmark trial appraisal
A concise appraisal of the randomised trial of MARS albumin dialysis in ACLF.
Open resource →Liver Trials
Critical Care Reviews · curated trial collection
A maintained collection of foundational trials in liver support, plasma exchange and critical care.
Open resource →