Related Experiment Videos
Clinical experience with a porcine hepatocyte-based liver support system
S C Chen1, W R Hewitt, F D Watanabe
1Department of Surgery, Cedars-Sinai Medical Center, UCLA School of Medicine, USA.
The International Journal of Artificial Organs
|November 1, 1996
Summary
A novel bioartificial liver (BAL) successfully bridged patients with fulminant hepatic failure (FHF) to liver transplant by reducing intracranial pressure. The BAL is not a substitute for orthotopic liver transplant in end-stage liver disease patients.
Area of Science:
- Hepatology and Transplant Surgery
- Biomedical Engineering
- Critical Care Medicine
Background:
- Fulminant hepatic failure (FHF) has limited treatment options, with orthotopic liver transplant (OLT) being the only definitive cure.
- High mortality rates in FHF patients occur while awaiting OLT, necessitating alternative supportive therapies.
- Extracorporeal liver support systems are crucial for bridging patients to OLT or recovery.
Purpose of the Study:
- To evaluate the efficacy of a novel bioartificial liver (BAL) support system in patients with severe acute liver failure.
- To assess the BAL's ability to serve as a bridge to OLT or spontaneous recovery.
- To investigate the impact of BAL treatment on intracranial pressure and key laboratory parameters in FHF patients.
Main Methods:
- Development of a BAL system utilizing plasma perfusion through a hollow-fiber cartridge seeded with matrix-anchored porcine hepatocytes.
- Clinical study involving two groups: Group 1 (n=12) with FHF and Group II (n=8) with chronic liver failure exacerbation.
- Monitoring of intracranial pressure (ICP), cerebral perfusion pressure (CPP), and biochemical markers pre- and post-BAL treatment.
Main Results:
- All 12 FHF patients in Group 1 were successfully bridged to OLT, with a mean bridge time of 39.3 hours.
- Significant reduction in ICP (18.2 to 8.5 mmHg) and increase in CPP (71.1 to 84.7 mmHg) observed in Group 1.
- BAL treatment showed improvements in glucose, ammonia, and total bilirubin levels in FHF patients; two patients in Group II survived to undergo OLT.
Conclusions:
- The bioartificial liver (BAL) shows promise as a bridge therapy for FHF patients, primarily by mitigating intracranial hypertension.
- The BAL is not a substitute for OLT in patients with end-stage liver disease who are not candidates for transplantation.
- Clinical experience suggests BAL can facilitate neurological recovery and improve hemodynamic parameters in FHF patients awaiting OLT.