The liver is the only organ which can regenerate and, thus, potentially negate the need for transplantation in acute liver failure (ALF). Cerebral edema and sepsis are leading causes of mortality in ALF. Both water-soluble and protein-bound toxins have been implicated in pathogenesis of various ALF complications. Ammonia is a surrogate marker of water-soluble toxin accumulation in ALF and high levels are associated with higher grades of hepatic encephalopathy, raised intracranial pressure, and mortality. Therefore, extracorporeal therapies aim to lower ammonia and maintain fluid balance and cytokine homeostasis. The most common and easily available modality is continuous kidney replacement therapy (CKRT). Early initiation of high-volume CKRT utilizing an anticoagulation regimen minimizing treatment downtime and delivering the prescribed dose is highly desirable. Ideally, extracorporeal liver-assist devices (ECLAD) should perform both synthetic and detoxification functions of the liver. ECLAD may temporarily replace lost liver function and serve as a bridge, either to spontaneous recovery or liver transplantation. Various bioartificial and biologic liver-assist devices are described in specialty literature, including molecular adsorbent recirculating system (MARS), single pass albumin dialysis (SPAD), and total plasma exchange (TPE); however, clinicians commonly use modalities easily available in intensive care units. There is a lack of standardization of indications for ECLAD, availability of different extracorporeal devices with varied technical approaches, and, of note, the differences in doses of ECLAD provided in clinical practice. We review the practicalities and evidence regarding these four artificial liver support devices in pediatric ALF.

肝脏是唯一可以再生的器官，因此在急性肝功能衰竭 (ALF) 中可能不需要移植。脑水肿和败血症是导致 ALF 死亡的主要原因。水溶性和蛋白质结合的毒素都与各种 ALF 并发症的发病机制有关。氨是 ALF 中水溶性毒素积累的替代标志物，高水平与更高级别的肝性脑病、颅内压升高和死亡率相关。因此，体外治疗旨在降低氨并维持体液平衡和细胞因子稳态。最常见和最容易获得的方式是持续肾脏替代疗法 (CKRT)。使用抗凝方案尽早开始大容量 CKRT 以最大限度地减少治疗停机时间并提供规定的剂量是非常可取的。理想情况下，体外肝脏辅助装置 (ECLAD) 应同时执行肝脏的合成和解毒功能。ECLAD 可以暂时替代失去的肝功能并充当自发恢复或肝移植的桥梁。专业文献中描述了各种生物人工和生物肝辅助装置，包括分子吸附再循环系统 (MARS)、单程白蛋白透析 (SPAD) 和全血浆交换 (TPE)；然而，临床医生通常使用重症监护病房中容易获得的方式。ECLAD的适应症缺乏标准化，具有不同技术方法的不同体外装置的可用性，值得注意的是，临床实践中提供的 ECLAD 剂量差异。我们回顾了这四种人工肝支持装置在儿科 ALF 中的实用性和证据。