The survival of patients with fulminant hepatic failure currently depends on avoiding intracranial hypertension, infection, and renal insufficiency. Supportive medical care and liver transplantation have been the only options. However, recent advances in the understanding of xenotransplantation and tissue engineering have lead to the development of extracorporeal liver support devices and presented new therapeutic options for the treatment of patients with fulminant hepatic failure. These devices may be based on mechanical purification, whole-organ perfusion, and the hybrid bioartificial liver (a combination of both mechanical and cell-based therapy). Recent studies have demonstrated the benefit of therapies that provide the differentiated metabolic function of primary hepatocytes.