Reply to Riva et al. Comment on "Gaspari et al. Blood Purification in Hepatic Dysfunction after Liver Transplant or Extensive Hepatectomy: Far from the Best-Case Scenarios

Wesincerely appreciate the authors’ comments [1] on our study [2]. Their criticism has allowed us to better elucidate our experience with CytoSorb® in patients with severe liver failure after liver transplantation or major liver resection. The literature provides limited data on the effects of CytoSorb® adsorption on this selected population of patients [3–5], which is why we found it important to highlight the peculiar aspects of our results. Thus far, most studies have focused on the effects of CytoSorb® in patients undergoing cardiac surgery without liver failure [6–8] or in critically ill patients with septic shock [9,10]. Notably, in two studies, despite the reported indication being ‘liver indication’ [11] or ‘acute liver dysfunction’ [12], the patients were critically ill individuals with multiple organ failure that included liver involvement rather than those with primary liver failure. This distinction is crucial, as it suggests that the liver dysfunction in these patients may be part of a more complex syndrome of critical illness, which could complicate the evaluation of treatment outcomes. Regarding the duration of individual treatments, we adhered to the manufacturer’s instructions, setting the maximum duration of a single treatment at 24 h. This approach was implemented to ensure optimal efficacy while maintaining patient safety during the adsorption process.