This document was published more than 2 years ago. The nature of the evidence may have changed.
Findings by Alert
This is a translation of version 1 published on April 28, 2000. The latest version of this report is not available in English.
To date, dialysis for acute hepatic failure has been tested on only a small number of patients in the world. Various dialysis methods for hepatic failure are intended to be used as a life supporting intervention while waiting for access to a liver suitable for transplantation. Without treatment, the patient would die within a few days. Currently there are three ways to perform liver dialysis. With albumin hemodiafiltration, the patients blood is filtered through a membrane which captures proteins but releases water-soluble substances and protein-bound toxins. In the second method, the patients blood is circulated through an animal liver located outside of the patients body. The third method involves filtering the patients blood through artificial columns containing liver cells from animals.
Currently, no* scientific evidence is available concerning patient benefit from dialysis in acute hepatic failure, neither in the short nor the long term. The potential risk for spreading infection via the use of cells or organs from animals has not been determined. Likewise, there is no scientific evidence regarding cost effectiveness. If this method is adopted in Sweden, the economic impact on the health services is expected to be minor since the target group for treatment is small.
The most promising method is albumin hemodiafiltration. The method is being studied in patients with chronic hepatic failure awaiting liver transplantation.
This assessment by SBU Alert uses a 4-point scale to grade the quality and evidence of the scientific documentation. The grades indicate: (1) good, (2) moderate, (3) poor, or (4) no scientific evidence on the subject.
This summary is based on a report prepared at SBU in collaboration with Prof Michael Olausson, MD PhD, Sahlgrenska University Hospital. It has been reviewed by Øystein H. Bentdal, MD, Rikshospitalet University hospital, Oslo.
Alert is a joint effort by the Swedish Council on Technology Assessment in Health Care (SBU), the Medical Products Agency, the National Board of Health and Welfare, and the Federation of Swedish County Councils.
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