A New Dawn for Liver Failure? NHS Trial Offers Hope Beyond Transplants
Seven out of ten people diagnosed with acute-on-chronic liver failure (ACLF) die within 28 days. This stark statistic underscores a critical need for innovation in treating this devastating condition, and a new NHS trial is poised to potentially rewrite the rules. Starting early next year, thirteen major hospitals will evaluate Dialive, a groundbreaking device offering a potential lifeline – and even a path to recovery – for patients where the only existing option is often a liver transplant.
Understanding the ACLF Crisis: A Rapidly Growing Threat
ACLF isn’t a chronic, slowly progressing illness; it’s a sudden and catastrophic deterioration in liver function, often triggered by underlying conditions like obesity, alcohol-related liver disease, and hepatitis. The speed of its onset is particularly alarming – three out of four individuals are only diagnosed after their condition has become life-threatening. This late diagnosis, coupled with the limited availability of liver transplants, creates a desperate situation for patients and healthcare providers alike.
The rising rates of liver disease are a significant public health concern. An estimated 2 million people in the UK currently have some form of liver disease, a figure that has quadrupled in the last 50 years. With cirrhosis – severe scarring of the liver – affecting around 60,000 people and claiming over 12,000 lives annually, the urgency for new treatments is undeniable. The increasing prevalence of non-alcoholic fatty liver disease (NAFLD), linked to obesity and metabolic syndrome, is further exacerbating the problem.
How Dialive Works: A ‘Liver Dialysis’ Breakthrough
Dialive, developed by UCL spinout company Yaqrit, functions as an “intensive care liver support system.” The device essentially performs a function akin to dialysis for the kidneys, but for the liver. It removes harmful substances, specifically dysfunctional albumin – a crucial protein produced by the liver – from the patient’s blood and replaces it with clean, functional albumin. This process aims to reduce the toxic load on the failing liver, allowing it to regenerate and other organs to recover.
The principle isn’t entirely new. Haemodialysis, a well-established treatment for kidney failure, paved the way for this approach. However, liver dialysis represents a significant leap forward, offering a potential bridge to recovery or, at the very least, stabilization for patients awaiting a transplant. Early results from a smaller 2023 study are encouraging: ten out of fifteen patients treated with Dialive saw their ACLF reversed, compared to only five out of fifteen receiving standard care. Patients using Dialive also experienced faster recovery times.
The Trial Details: Who Will Benefit?
The £2.2m trial, funded by the National Institute for Health and Care Research (NIHR), will involve 72 seriously ill patients across thirteen NHS teaching hospitals, including King’s College, University College London, and the Queen Elizabeth Hospital Birmingham. Participants will already be suffering from multiple organ failures, making them among the sickest patients in intensive care. They will receive Dialive treatment sessions on their first, second, and third days, with the possibility of up to four additional sessions within the first ten days.
“Our goal is to demonstrate that we can resolve life-threatening ACLF more often and faster than standard care,” explains Rajiv Jalan, a senior liver specialist and co-principal investigator of the trial. “These are gravely ill patients with multi-organ failure and high risk of death, so there is a desperate need for effective treatments not only here but all around the world.”
Beyond Dialive: The Future of Liver Disease Treatment
The potential success of Dialive isn’t just about this one device. It signals a broader shift towards proactive liver support and regeneration therapies. Researchers are increasingly exploring strategies to modulate the inflammatory response that drives ACLF, as highlighted by Dr. Rohit Saha, a trial co-principal investigator. “Many [patients with ACLF] die because their bodies become trapped in a destructive cycle of inflammation that current treatments can’t reverse,” he notes. Dialive offers a potential way to break that cycle.
Looking ahead, we can anticipate several key trends:
- Personalized Medicine: Tailoring treatment strategies based on individual patient characteristics and the specific cause of their liver failure.
- Early Detection: Improved diagnostic tools and screening programs to identify liver disease at earlier, more treatable stages.
- Regenerative Medicine: Continued research into therapies that promote liver regeneration, potentially reducing the need for transplants.
- Artificial Liver Support: Further development of devices like Dialive, potentially leading to more portable and efficient systems.
The NIHR’s investment in this trial reflects a growing recognition of the need for innovative solutions. As Prof. Mike Lewis, its scientific director for innovation, states, “If this NIHR-funded trial of Dialive is successful, it will bring dramatic benefits for patients, providing a treatment for ACLF that will save lives and reduce hospital stay.”
What are your predictions for the future of liver disease treatment? Share your thoughts in the comments below!
