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The concept that a bioartificial device could compensate for the loss of hepatic function and thus improve the outcome of acute liver failure (ALF) was first suggested more than three decades ago. Currently, and reflecting renewed interest in this possibility, three such devices are undergoing clinical evaluation. Each has been shown to perform metabolic functions normally performed by the liver, thus affecting the serum biochemistry of patients with ALF. However, despite potential merit, these devices have not yet been shown to improve the outcome of patients with ALF. Also, some major safety issues remain to be resolved, in particular the risk of transmission of unknown zoonoses to man.