If an effective hepatic assist system existed, it could serve as a bridge to transplantation. Most of the patients waiting for liver transplantation have chronic liver insufficiency but are not in hepatic coma. Various hepatic assist systems have been used to salvage patients with acute liver insufficiency. Most attempts have been disappointing. The methods used have included plasma exchange, plasma adsorption, double filtration, cryofiltration, thermofiltration, the combination of plasma exchange and amino acid hemodialysis, and others. For patients with chronic liver disease with moderate liver function impairment and limited to one or only a few areas of metabolic abnormality, a hepatic assist might allow the life of the patient to be maintained temporarily. The application of hepatic assist methods for chronic liver disease patients treated at the Cleveland Clinic has been encouraging. One of the patients who suffered from sclerosing cholangitis has maintained a near-normal life for almost five years by 170 plasma treatments. This is in spite of the fact that, at the onset of treatment, the patient was nearly comatose. Unfortunately, this patient did not wish to receive a liver transplantation. Based upon this experience, the concept of a bridge to transplantation approach to hepatic assist devices appears feasible. In addition, it is speculated that hepatic assistance during the early recovery stage of liver transplantation and during mild episodes of rejection may be useful.