Extracorporeal therapies for post-liver transplant recipient: The road less traveled

Abstract

Extracorporeal therapies have a definite role in patients with acute liver failure, acute on-chronic liver failure, and progressive chronic liver disease. They act as a bridge-to-transplant in these patients. With the increasing success of liver transplantation, the immediate postoperative complication spectrum continues to expand. Extracorporeal therapies can play an important role in managing these complications. However, the literature on extracorporeal therapies in the post-liver transplant period is limited. This review article discussed various extracorporeal therapies that are still evolving or marred by limited evidence but can improve patient outcomes. These extracorporeal therapies can be divided into two subgroups: (1) Therapies for infective complications. Endotoxin and cytokine adsorption columns; and (2) Therapies for noninfective complications like small for size syndrome, primary allograft nonfunction, early allograft dysfunction, hyperacute rejection, hepatopulmonary syndrome, etc. (plasma exchange, double plasma molecular adsorption, molecular adsorbent recirculation system, and extracorporeal membrane oxygenation, among others).

Keywords: Critical care; Intensive care unit; Liver transplant; Extracorporeal therapies; Polymyxin B hemoperfusion; Cytokine adsorption; Therapeutic plasma exchange; Molecular adsorbent recirculation system; Extracorporeal membrane oxygenation

Core Tip: With the growing number of liver transplants, both infective and noninfective complications are bound to grow. The discussion on extracorporeal therapies sheds light on innovative approaches that may improve patient outcomes, showcasing advancements in medical technology. By acknowledging the limited literature and ongoing research, the article highlighted the need for further studies to validate the efficacy and safety of these emerging therapies, which is crucial for informed clinical practice.