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Treatment of Severe Liver Failure with a Bioartificial Liver a
Author(s) -
CHEN STEVE C.,
MULLON CLAUDY,
KAHAKU ELAINE,
WATANABE FRED,
HEWITT WINSTON,
EGUCHI SUSUMU,
MIDDLETON YVETTE,
ARKADOPOULOS NIKOLAOS,
ROZGA JACEK,
SOLOMON BARRY,
DEMETRIOU ACHILLES A.
Publication year - 1997
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1111/j.1749-6632.1997.tb52210.x
Subject(s) - medicine , bioartificial liver device , liver transplantation , hemoperfusion , exacerbation , liver failure , gastroenterology , sepsis , chronic liver disease , fulminant hepatic failure , liver disease , surgery , transplantation , hepatocyte , cirrhosis , hemodialysis , biochemistry , chemistry , in vitro
Orthotopic liver transplantation (OLT) is the definitive therapy for severe liver failure. However, many patients die before an organ becomes available, mostly from cerebral edema. To provide temporary liver support, we developed a bioartificial liver (BAL) based on porcine hepatocytes and a charcoal column. Fifty-four consecutive BAL treatments were carried out in three groups of patients: Group I (n = 15) patients presented with FHF were listed for emergent OLT, Group II (n = 3) patients with primary non-function (PNF) of their liver grafts required urgent re-transplantation and Group III (n = 10) patients with acute exacerbation of chronic liver disease were not candidates for OLT. Patients were managed in a critical care unit receiving maximal standard support. Each BAL treatment was conducted for 6 hours. In Group I, all patients showed significant neurologic improvement, intracranial pressure (ICP) decreased and cerebral perfusion pressure (CPP) increased; other significant improvements, included lowered plasma ammonia and liver enzymes and increased glucose. One patient recovered spontaneously without OLT, all other patients were "bridged" to OLT, and recovered. Group II: PNF patients showed similar benefits. Group III: Chronic liver patients demonstrated transient beneficial effects after BAL treatment(s), however, most (n = 8) eventually succumbed to sepsis and multiple organ failure as they were not candidates for OLT; two patients, recovered, later were successfully transplanted and survived. Our clinical experience demonstrates that the BAL can serve as a bridge to OLT in patients with acute liver failure.