Extracorporeal liver support
A functioning liver is essential to sustain life. NHS England states that no practical artificial device is currently available to support or replace a failing liver, and that liver transplantation is therefore the only life-saving therapy available.
NICE found that evidence on extracorporeal albumin dialysis for acute liver failure raises no major safety concerns, but that current evidence on its efficacy is inadequate in quality and quantity. It restricted the procedure to use with special arrangements for clinical governance, consent and audit or research.
NICE — Section 1 Recommendations, recommendation 1.1 · NICE — Section 1 Recommendations, recommendation 1.1, restriction clause
The exact wording of the source
Section 1 Recommendations, recommendation 1.1 · status: current, verified 2026-09-02
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The evidence on extracorporeal albumin dialysis for acute liver failure raises no major safety concerns. However, current evidence on its efficacy is inadequate in quality and quantity.
Section 1 Recommendations, recommendation 1.1, restriction clause · status: current, verified 2026-09-02
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Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
The same guidance places a duty on clinicians to ensure that patients and their carers understand the uncertainty about the procedure's efficacy, and to provide clear written information, subject to the requirement for an emergency procedure.
NICE — Section 1 Recommendations, recommendation 1.2, second bullet
The exact wording of the source
Section 1 Recommendations, recommendation 1.2, second bullet · status: current, verified 2026-09-02
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Ensure that patients and their carers understand the uncertainty about the procedure's efficacy and provide them with clear written information (subject to the requirement for an emergency procedure).
What the procedure aims to do is support the patient until either their own liver function recovers or a transplant becomes available, removing toxins bound to albumin in the blood as well as the water-soluble toxins that haemodialysis can remove. That is a statement of intent, not of demonstrated effect.
NICE — Section 2 The procedure, 2.2 Outline of the procedure, 2.2.1
The exact wording of the source
Section 2 The procedure, 2.2 Outline of the procedure, 2.2.1 · status: current, verified 2026-09-02
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This procedure aims to support the patient until either their own liver function recovers or a transplant becomes available. The procedure removes toxins bound to albumin in the blood in addition to the water-soluble toxins that can be removed by haemodialysis.
For extracorporeal whole liver perfusion in acute liver failure, NICE found serious, well-recognised safety complications and inadequate efficacy evidence, and restricted the procedure to use only in the context of research. That is a stricter restriction than the one above, and the two are not interchangeable.
NICE — Section 1 Recommendations, recommendation 1.1
The exact wording of the source
Section 1 Recommendations, recommendation 1.1 · status: current, verified 2026-09-02
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Evidence on the safety of extracorporeal whole liver perfusion for acute liver failure shows serious, well-recognised complications. Evidence on efficacy is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research.
European guidance on acute liver failure states that liver support systems, biological or adsorbent, should only be used in the context of a randomised controlled trial.
European Association for the Study of the Liver — Section 'Artificial and bioartificial liver devices', Recommendations box, journal page 1068
The exact wording of the source
Section 'Artificial and bioartificial liver devices', Recommendations box, journal page 1068 · status: current, verified 2026-09-01
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Liver support systems (biological or adsorbent) should only be used in the context of RCT (evidence level II-1, grade of recommendation 1).
European guidance on acute-on-chronic liver failure — a different population — states that routine use of artificial or bioartificial extracorporeal liver support, or of plasma exchange, is not recommended outside investigative trials.
European Association for the Study of the Liver — Summary of recommendations table, journal page 485
The exact wording of the source
Summary of recommendations table, journal page 485 · status: current, verified 2026-09-01
Publisher restricts automated access
The routine use of artificial or bioartificial extracorporeal liver support or plasma exchange in ACLF is not recommended outside investigative trials (LoE 2, strong recommendation).
The same guidance states that although albumin dialysis can improve the severity of hepatic encephalopathy, there is no evidence that it improves survival in acute-on-chronic liver failure.
European Association for the Study of the Liver — Summary of recommendations table, journal page 485
The exact wording of the source
Summary of recommendations table, journal page 485 · status: current, verified 2026-09-01
Publisher restricts automated access
Although albumin dialysis can improve the severity of hepatic encephalopathy, there is no evidence it improves the survival of patients with ACLF (LoE 2).
In the evidence NICE considered, a meta-analysis reported no significant difference in 30-day all-cause mortality between patients who had extracorporeal albumin dialysis and those who had standard medical treatment.
NICE — Section 2 The procedure, 2.3 Efficacy, 2.3.1
The exact wording of the source
Section 2 The procedure, 2.3 Efficacy, 2.3.1 · status: current, verified 2026-09-02
Open
reported no significant difference in 30‑day all-cause mortality between patients who had extracorporeal albumin dialysis and those who had standard medical treatment (relative risk [RR] 0.56; 95% confidence interval [CI] 0.28 to 1.14; p=0.11)
Related
- Post-hepatectomy liver failure — is used to treat
- Liver transplantation — related through post-hepatectomy liver failure
- Liver resection — related through post-hepatectomy liver failure
- ISGLS PHLF grading — related through post-hepatectomy liver failure
What we have not established
Relationships involving Extracorporeal liver support that we have not evidenced are listed, never drawn — a line would read as a weak relationship, which is a different and false claim.
- None recorded for this concept.
Evidence search date: 2026-09-02
Content reviewed and approved
What we have not established here
Known gaps on this concept:
MACHINE PERFUSION IS DELIBERATELY ABSENT. Evidence that NICE recommends four ex-situ machine perfusion devices for NHS use, and that NHSBT has funded a national rollout of abdominal normothermic regional perfusion, was acquired and verified in this phase and is not rendered here. Those technologies act on a DONOR ORGAN before transplantation, not on the patient's own liver. An adversarial review found that placing them beside liver support devices would manufacture the impression that the NHS routinely funds machines that support failing livers. They belong to a transplantation concept that does not exist yet.
THE ISGLS POINTER IS NOT FULLY CLOSED, and closing it with this evidence would be an editorial inference dressed as a citation. The platform's post-hepatectomy liver failure concept cites ISGLS grade C, which names 'extracorporeal liver support' among its defining invasive procedures. Everything on this page concerns ACUTE liver failure (NICE, EASL 2017) or ACUTE-ON-CHRONIC liver failure (EASL 2023). Nothing held gives the status of any liver support modality in the post-hepatectomy setting, and nothing establishes that ISGLS's phrase denotes albumin dialysis at all.
No plain-language account of what these machines are. The plain layer carries one statement: that no practical artificial device is currently available. That is the honest answer to the question a family actually asks, and everything else on this page is about evidence status rather than about a treatment.
The NICE albumin dialysis guidance dates from 2009 and was last reviewed on publication - seventeen years before the Cochrane review cited here.
The ATMP regulatory material acquired this phase - the statutory definition of an advanced therapy medicinal product, the marketing authorisation requirement, and the hospital exemption conditions - is not rendered. It is legal scaffolding with no liver-specific content, and the hospital exemption in particular was flagged as readable by a determined reader as a route to access rather than as a restriction.
What has changed here
2026-09-02 — Concept created at plain, clinical, specialist and research resolutions - the platform's first concept to offer research depth.
Phase 17. The platform published the ISGLS grade C definition naming extracorporeal liver support and held nothing about it. This concept states what the UK bodies that decide have decided, and leads with the fact that no practical artificial device is currently available.