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Bioartificial liver support devices: historical perspectives
Author(s) -
Court Fiona G.,
WemyssHolden Simon A.,
Dennison Ashley R.,
Maddern Guy J.
Publication year - 2003
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1046/j.1445-2197.2003.02741.x
Subject(s) - medicine , fulminant hepatic failure , bioartificial liver device , liver transplantation , immunosuppression , intensive care medicine , detoxification (alternative medicine) , transplantation , life expectancy , liver function , economic shortage , fulminant , surgery , hepatocyte , pathology , population , biochemistry , chemistry , linguistics , alternative medicine , environmental health , philosophy , government (linguistics) , in vitro
Fulminant hepatic failure (FHF) is an important cause of death worldwide. Despite significant improvements in critical care therapy there has been little impact on survival with mortality rates approaching 80%. In many patients the cause of the liver failure is reversible and if short‐term hepatic support is provided, the liver may regenerate. Survivors recover full liver function and a normal life expectancy 1 . For many years the only curative treatment for this condition has been liver transplantation, subjecting many patients to replacement of a potentially self‐regenerating organ, with the lifetime danger of immunosuppression and its attendant complications, such as malignancy 2 . Because of the shortage of livers available for transplantation, many patients die before a transplant can be performed, or are too ill for operation by the time a liver becomes available. Many patients with hepatic failure do not qualify for liver transplantation because of concomitant infection, metastatic cancer, active alcoholism or concurrent medical problems. The survival of patients excluded from liver transplantation or those with potentially reversible acute hepatitis might be improved with temporary artificial liver support. With a view to this, bioartificial liver support devices have been developed which replace the synthetic, metabolic and detoxification functions of the liver. Some such devices have been evaluated in clinical trials 3,4 . During the last decade, improvements in bioengineering techniques have been used to refine the membranes and hepatocyte attachment systems used in these devices, in the hope of improving function. The present article reviews the history of liver support systems, the attendant problems encountered, and summarizes the main systems that are currently under evaluation.