NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 7 sources, which was discussed by the committee. The evidence included 1 systematic review, 5 case series and 1 case report. It is presented in table 2 of the interventional procedures overview. Other relevant literature is in the appendix of the overview.
The professional experts and the committee considered the key efficacy outcomes to be: survival, improvement in neurological outcomes and bridge to transplantation.
The professional experts and the committee considered the key safety outcomes to be: thrombotic events, hyperkalaemia causing cardiac arrhythmia and septicaemia.
No patient commentary was sought because it was not feasible for patients with acute liver failure to offer commentary for this procedure.
The committee noted that much of the evidence reviewed came from studies done some years ago.
Recent advances in the intensive care management of acute liver failure and liver transplantation have made the data on patient selection, safety and efficacy outcomes difficult to interpret in the context of current practice.
The committee was informed that, if clinically appropriate, patients having this procedure should be listed with NHS Blood and Transplant for an urgent transplant. But the committee noted that this procedure can also be used for patients who are unable to have, or do not need, liver transplantation.
ISBN: 978‑1‑4731‑4056‑1