Bridging Therapies in ACLF

Bridging therapies in ACLF are used for bridging to liver transplant (LT) and to spontaneous recovery.

Plasma exchange is the most studied and has better evidence of survival improvement in ACLF as compared to other modalities. 

Extracorporeal cellular therapy, molecular adsorbent recirculating system and fractionated plasma separation and adsorption therapies have been explored, but studies are small and have shown no survival benefi t. There is poor quality of evidence.

Timing of LT is important in ACLF. Infection, organ failure, logistics, delay in donor availability preclude LT.

Adverse events are volume related. More RCTs are needed to place in a management algorithm.

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