Eight RCTs (355 participants) were included in the review. Randomisation and sequence generation procedures were adequately reported in three RCTs. Details of allocation concealment were reported in five RCTs. None of the included studies were blinded. Two studies provided sample size calculations; sufficient recruitment was achieved in these studies. Follow-up ranged from 27 to 180 days.
Extracorporeal liver support therapy improved survival in acute liver failure (RR 0.70, 95% CI 0.49 to 1.00; three RCTs, Ι²=0%). The number needed to treat to prevent one death in acute liver failure was eight. There were no significant differences for mortality between extracorporeal liver support and standard medical therapy for acute-on-chronic liver failure (RR 0.87, 95% CI 0.64 to 1.18; five RCTs, Ι²=35%). There was no evidence of publication bias.
There were also no significant differences for short-term mortality in acute liver failure at seven days (one RCT) or 10 days (three RCTs). There were no significant differences between extracorporeal liver support and standard medical therapy for adverse events. Results for hepatic encephalopathy, biochemical parameters, adverse events and sensitivity analysis of case-control studies and excluded RCTs were reported.