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Related Experiment Videos

Technology insight: liver support systems.

J Michael Millis1, Julian E Losanoff

  • 1University of Chicago, Chicago, Illinois, USA. mmillis@surgery.bsd.uchicago.edu

Nature Clinical Practice. Gastroenterology & Hepatology
|November 3, 2005
PubMed
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Liver assist devices offer a potential bridge to liver transplantation for patients with fulminant hepatic failure (FHF). While promising, these systems require further research for widespread clinical acceptance and to reduce mortality rates.

Area of Science:

  • Hepatology
  • Biomedical Engineering
  • Transplantation Medicine

Background:

  • Fulminant hepatic failure (FHF) necessitates emergency orthotopic liver transplantation (OLT), but lengthy waiting times contribute to high mortality.
  • Current liver assist devices lack FDA approval and widespread clinical acceptance, despite encouraging experimental results.

Purpose of the Study:

  • To review the historical and current landscape of liver support systems for patients with FHF.
  • To evaluate the potential of liver assist devices as a bridge to OLT and explore their role in patient recovery.

Main Methods:

  • Overview of published experience with liver support systems since the 1960s.
  • Discussion of nonbiologic (blood/plasma sorption) and biologic (xenogeneic livers/hepatocytes) approaches.

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  • Analysis of data from experimental and clinical trials, including dialysis methods.

    • Main Results:

    • Nonbiologic systems aim to remove circulating toxins implicated in hepatic coma.
    • Biologic systems leverage cellular functions for detoxification, metabolism, and biosynthesis.
    • Classical dialysis methods show potential in acute-on-chronic liver failure but require larger studies.

    Conclusions:

    • Liver assist devices represent a developing field with the potential to decrease mortality in FHF patients awaiting OLT.
    • Further large-scale studies in specialized centers are needed to establish the definitive role of bioartificial liver support systems.
    • The ultimate goal is to facilitate recovery without transplantation by removing critical toxins.