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Early clinical experience with a hybrid bioartificial liver
A A Demetriou1, J Rozga, L Podesta
1Liver Support Unit, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Background:
Severe liver failure is associated with high mortality. Orthotopic liver transplantation (OLT) is the only effective therapeutic modality; there is a need for a 'bridge' system to support patients until an organ becomes available.
Methods:
A bioartificial liver (BAL) was used to treat 10 patients with severe liver failure. A plasmapheresis system was used to pump patient plasma through a module with porcine hepatocytes. Each treatment lasted 6-7 h.
Results:
All patients tolerated the procedure(s) well. Eight patients underwent OLT following BAL treatment(s). There were two late deaths after recovery from liver failure. Five patients with increased intracranial pressure (ICP) and decerebration had ICP normalization, increased cerebral perfusion pressure and full neurologic recovery after OLT. There was improvement in the level of encephalopathy and a significant decrease in serum ammonia after BAL treatment(s).
Conclusions:
BAL treatment is safe and beneficial and can be successfully used as a 'bridge' to transplantation.