Advanced functional materials in hemoperfusion liver treatment: Recent advances, challenges, and prospects

Hyperbilirubinemia is a life-threatening disease of liver failure. Hemoperfusion (HP) effectively adsorbs excess bilirubin from the bloodstream, gaining widespread clinical recognition due to its mature technology, straightforward operation, and low cost. The treatment efficacy of HP primarily depends on the performance of the adsorbent material. Consequently, the development of highly efficient, selective, and biocompatible adsorbents has become a key research focus in this field. In recent years, numerous bilirubin adsorbents with outstanding adsorption capacity and biocompatibility have been developed. This review summarizes the developmental trajectory of bilirubin adsorbents, tracing their evolution from traditional single-component materials to complex composite structures engineered for synergistic functionality. It first clarifies the mechanisms of bilirubin adsorption, providing a theoretical basis for the design of materials. Subsequently, it comprehensively reviews diverse adsorbent materials, including inorganic oxides, carbon-based materials, polymers, and framework materials, with particular empHasis on the emerging composite synergistic strategies. A key highlight of this review lies in its pioneering systematic integration of design evolution from monomeric materials to composite structures. It further identifies current research challenges and future development directions, offering crucial guidance and forward-looking perspectives for the rational design of next-generation HP adsorbents that combine high efficiency, biosafety, and clinical applicability.