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Biotechnologies and acute hepatic failure.

L R Fassati1, S Gatti, L Caccamo

  • 1Istituto di Chirurgia Sperimentale e dei Trapianti, Università di Milano, Unità Operativa per il Trapianto e la Chirurgia del Fegato e del Polmone, Ospedale Maggiore IRCCS, Milano.

Forum (Genoa, Italy)
|January 29, 2000
PubMed
Summary

Extra-corporeal liver perfusion shows promise for acute liver failure patients awaiting transplants. This experimental study demonstrated improved ammonia and lactate levels in pigs receiving hepatic support, suggesting a potential bridge to transplantation.

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Area of Science:

  • Hepatology
  • Transplantation Surgery
  • Biomedical Engineering

Background:

  • Orthotopic liver transplantation survival rates for acute liver failure (ALF) are suboptimal, with high waiting list mortality due to donor scarcity.
  • Developing methods to temporarily sustain hepatic function is crucial for patients with ALF awaiting liver transplantation.

Purpose of the Study:

  • To evaluate the efficacy of extra-corporeal liver perfusion as a temporary support system for acute liver failure.
  • To assess the impact of continuous allo-perfusion using the Abouna-Costa circuit on physiological parameters in a porcine model of ALF.

Main Methods:

  • Acute liver failure was induced in pigs via total liver de-vascularisation.
  • Group 1 (n=4) received no support and served as a control.

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  • Group 2 (n=8) received continuous allo-perfusion of the isolated liver using the Abouna-Costa extra-corporeal circuit.

    • Main Results:

    • Control pigs (Group 1) all died within 16-33 hours post-induction of ALF.
    • Pigs receiving extra-corporeal hepatic support (Group 2) survived the ALF period (6.30-7.30 hours).
    • Significant improvements in ammonia and lactate levels were observed following the application of extra-corporeal hepatic assistance.

    Conclusions:

    • Extra-corporeal liver perfusion using the Abouna-Costa circuit can sustain hepatic function in a porcine model of acute liver failure.
    • This approach demonstrates potential for improving metabolic derangements associated with ALF and may serve as a bridge to liver transplantation.