Long-term bridging of acute on chronic liver failure to successful transplantation with an extracorporeal liver support system

We report the case of a 38-year-old Caucasian male who was admitted because of end-stage liver failure due to primary sclerosing cholangitis. Because of the rapidly progressive severe hepatic encephalopathy and development of hepatorenal syndrome type 1, the patient was immediately upgraded to a high priority status on the liver transplantation waiting list T2 status according to Eurotransplant criteria). Intermittent therapy with an extracorporeal liver support system (Prometheus (R)) was initiated in order to bridge the time period until the expected transplantation date. Under therapy with the extracorporeal liver support system, total serum bilirubin decreased significantly from 33 to 15 mg/dL after 8 sessions. Simultaneously the encephalopathy resolved gradually within 3 weeks (10 sessions) from initially grade 3 to grade 1. Extracorporeal detoxification therapy was continued for 51 days (23 sessions) until the patient underwent his successful liver transplantation in good general clinical condition. Prometheus (R), a new liver support system, seemed to sufficiently replace hepatic detoxification on a long-term basis in this patient with end-stage liver failure in order to bridge the time period until liver transplantation.