Recompensation of Exacerbated Liver Insufficiency With Hyperbilirubinemia and/or Encephalopathy and/or Renal Failure

Inclusion Criteria: * Signed written informed consent by patient or next of kin * Age greater than 18 years * Patients with a recent clinical severe decompensation of a presumed cirrhosis (based on clinical evaluation or radiological imaging) related to a precipitating (trigger) event (e.g. infection, bleeding, alcohol abuse) * Intrahepatic cholestasis (bilirubin greater than 5 mg/dl or greater than 85 µmol/l, respectively) without evidence of extrahepatic origin * and at least one of the following three: * Hepatorenal syndrome (impaired renal function with creatinine greater than 1.5 mg/dl or greater than 133µmol/l without evidence of reduced vascular volume \[e.g. central venous pressure {CVP} greater than 8 cm H2O\] and no evidence of pre-existing renal failure) * Hepatic Encephalopathy greater than or equal to II° * Progressive Hyperbilirubinaemia: defined as a more than 50% increase of bilirubin before enrolment, whether in referral or currently in hospital up to a level of greater than 20 mg/dl (or greater than 340 µmol/l) Exclusion Criteria: * Progressive jaundice and deterioration as a natural course of a chronic liver disease without precipitating (trigger) event * Severe thrombocytopenia (platelet count less than or equal to 50 Glutamic Pyruvic Transaminase \[GPT\]/l) * Severe coagulopathy (International Normalised Ratio \[INR\] greater than 2.3) * Need for renal replacement therapy within three days prior to enrolment * Severe infection without antibiotic treatment for at least 24 hours. Uncontrolled bacterial infection * Active bleeding within 48 hours prior to enrolment * Proven hepatocellular carcinoma (HCC) greater than 4 cm or infiltration of portal vein or acute portal vein thrombosis * Severe cardiopulmonary disease (New York Heart Association \[NYHA\] greater than or equal to 2) * Pregnancy/lactation * Mean arterial pressure (MAP) less than 60 mmHg despite vasopressor agents (norepinephrine greater than 1 µg/kg/min) for blood pressure support * Overt clinical evidence for Disseminated Intravascular Coagulation (DIC) * Clinical evidence for coma of non-hepatic origin * Extra-hepatic cholestasis * Severe intrinsic renal disease * Extended surgical procedure within the last four weeks or unsolved surgical problems * Known human immunodeficiency virus (HIV) infection