The liver is a complex organ that performs vital functions of synthesis, heat production, detoxification and regulation; its failure carries a highly critical risk. At the end of the last century, some artificial liver devices began to develop with the aim of being used as supportive therapy until liver transplantation (bridge-to-transplant) or liver regeneration (bridge-to-recovery).

In the following years, experimental works and early clinical applications were reported, and to date, many thousands of patients have already been treated with these devices. The ability of artificial liver support systems to replace the liver detoxification function, at least partially, has been proven, and the correction of various biochemical parameters has been demonstrated.

The MARS has been the most widely researched and used ECLSD to date. MARS uses a hollow-fiber polysulfone dialysis membrane with low (less than 60 kDa) cutoff, rendering it impermeable to albumin. Similar to SPAD, albumin-bound toxins are removed via the counter current albumin enriched dialysate.

Bioartificial livers utilize membranes to retain the hepatocytes, prevent hepatocyte–blood cell contact, and maximize mass transfer of toxins, oxygen, and nutrients to the hepatocytes and synthetic products to the patient’s blood.