Liver support strategies: cutting-edge technologies

Despite almost three decades of research on artificial and bioartificial liver support, appropriate, randomized, controlled, and adequately powered studies are rareCompared with the effect of a suitable orthotopic liver graft on a patient's clinical course, the clinical effects of extracorporeal liver support systems seem to be very limitedThe main issues for all liver support therapy concepts are the need for tissue vascularization and integration into the host circulation, and a lack of reliable sources of safe and metabolically active cellsStrategies to overcome the conceptual limitations of (bio)artificial liver support devices include hepatocyte transplantation and various tissue engineering approaches (for example repopulation of decellularized organs, organ printing and induced organogenesis)Hepatocyte transplantation seems to be at least a temporary alternative treatment strategy in certain metabolic liver disorders, and might have a role in the treatment of acute liver failure and chronic liver diseaseTranslation of regenerative medicine into the clinical routine, especially transplantation of recellularized liver grafts, seems possible but further intense research is needed