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. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Clinicians wishing to undertake extracorporeal albumin dialysis for acute liver failure should take the following actions.
Inform the clinical governance leads in their Trusts.
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). In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having extracorporeal albumin dialysis for acute liver failure (see section 3.1).
NICE encourages further research into extracorporeal albumin dialysis for acute liver failure. This should describe clearly the indications for treatment. Short- and longer-term survival and the numbers of patients 'bridged to transplant' should be documented and compared with standard treatments. Further information about the utility of biochemical markers to guide the frequency of treatment would be helpful. NICE may review the procedure on publication of further evidence.