Assess Safety and Efficacy of ELAD (Extracorporeal Liver Assist System) in Subjects With Alcohol-Induced Liver Failure

Inclusion Criteria:

   - Age ≥ 18 years;

   - Total bilirubin ≥ 8 mg/dL;

   - A clinical diagnosis of alcohol-induced liver decompensation (AILD), based upon
   evidence (by lab test, medical history, or family interview) of a clinical judgment of
   a temporal (6 weeks or less) and causal relationship between use of alcohol and this
   onset of symptoms;

   - Subjects meeting inclusion criteria 1 through 3 will be classified as having either:

   a. Severe acute alcoholic hepatitis (AAH), with: i. Medical history of alcohol abuse;
   AND ii. Maddrey score of ≥ 32; AND iii. AAH documented by either:

   1. Confirmatory liver biopsy; OR 2. Two or more of the following:

      1. Hepatomegaly,

      2. AST > ALT,

      3. Ascites,

      4. Leukocytosis (WBC count above lab normal at site), OR

   b. Alcohol-induced decompensation of chronic liver disease that is not acute alcoholic
   hepatitis (as defined above), with: i. MELD score of 18-35; AND ii. Underlying chronic
   liver disease documented by:

      1. Liver biopsy, AND/OR

      2. Laboratory findings, AND/OR

      3. Medical history;

   - Not eligible for liver transplant during this hospitalization;

   - Subject or legally authorized representative must provide Informed Consent;

   - Subject must be eligible for Standard of Care treatment as defined in the protocol.

Exclusion Criteria:

   - Platelet count < 40,000/mm3;

   - International Normalization Ratio (INR) > 3.5;

   - MELD Score > 35;

   - AST > 500 IU/L;

   - Evidence of infection unresponsive to antibiotics;

   - Evidence of reduction in total bilirubin of 20% or more in the previous 72 hours, if
   available. Bilirubin measurements must be taken at least 12 hours after any procedure
   known to artificially alter serum bilirubin (e.g., administration of packed red blood
   cells, plasma exchange);

   - Evidence of hemodynamic instability as defined by the following:

      1. Systolic blood pressure < 90 mmHg with evidence of diminished perfusion
      unresponsive to fluid resuscitation and/or low-dose pressor support; OR

      2. Mean arterial pressure (MAP) < 60 mmHg with evidence of diminished perfusion
      unresponsive to fluid resuscitation and/or low-dose pressor support; OR

      3. Requirement for escalating doses of vasopressor support prior to Screening; OR

      4. Subject at maximum vasopressor dose at Screening;

   - Evidence of active bleeding or of major hemorrhage defined as requiring ≥ 2 units
   packed red blood cells to maintain stable hemoglobin occurring within 48 hours of
   Screening;

   - Clinical evidence of liver size reduction due to cirrhosis (liver size of the
   craniocaudal diameter (sagittal view) < 10 cm when measured on the mid clavicular line
   (or equivalent measurement) by ultrasound, or liver volume < 750 cc as determined by
   CT), unless Investigator interpretation of the clinical evidence indicates liver size
   of < 10 cm or volume < 750 cc is not considered reduced for the individual subject;

   - Occlusive portal vein thrombosis impairing hepatopetal flow, or evidence of bile duct
   obstruction;

   - Evidence by physical exam, history, or laboratory evaluation, of significant
   concomitant disease with expected life expectancy of less than 3 months, including,
   but not limited to:

      1. Severe acute or chronic cardiovascular, central nervous system, or pulmonary
      disease;

      2. Cancer that has metastasized or has not yet been treated;

   - Subject has chronic end-stage renal disease requiring chronic hemodialysis for more
   than 8 weeks (not classified as hepatorenal syndrome);

   - Subject has liver disease related to homozygous hemachromatosis, Wilson's Disease, has
   non-alcoholic fatty liver disease, or Budd-Chiari Syndrome;

   - Pregnancy as determined by β-human chorionic gonadotropin (HCG) results, or lactation;

   - Participation in another investigational drug, biologic, or device study within one
   month of enrollment, except for observational studies (the observational study setting
   should not affect safety and/or efficacy of the VTI-208 clinical trial);

   - Previous liver transplant;

   - Previous enrollment in the treatment phase of another ELAD trial (e.g. a subject is
   not disqualified from enrollment in VTI-208 if they were screened for VTI-210 but did
   not qualify for enrollment in the treatment phase of the study and therefore did not
   receive ELAD or Control treatment;

   - Have a Do Not Resuscitate or a Do Not Intubate (DNR/DNI) directive (or such local
   equivalent) or any other Advanced Directive limiting Standard of Care in place (the
   DNR/DNI criterion is not applicable in the UK);

   - Refusal to participate in the VTI-208E follow-up study;

   - Inability to provide an address for home visits.