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[The artificial liver--an interim report]

H G Koebe1, F W Schildberg

  • 1Chirurgische Universitätsklinik und Poliklinik, Ludwig-Maximilians-Universität, München, Bundesrepublik Deutschland.

Wiener Klinische Wochenschrift
|October 23, 1998
PubMed
Summary

Bioartificial Liver (BAL) devices show limited success in treating liver failure. Critical issues in research and clinical application remain unresolved, necessitating further investigation before widespread use.

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Area of Science:

  • Hepatology
  • Biomedical Engineering
  • Regenerative Medicine

Background:

  • Bioartificial Liver (BAL) devices aim to support or replace liver function in patients with liver failure.
  • Despite research since 1998, no BAL system has achieved widespread clinical importance.
  • Significant challenges hinder the development and validation of effective BAL technologies.

Purpose of the Study:

  • To review and analyze the clinical applications of Bioartificial Liver (BAL) systems reported up to 1998.
  • To critically evaluate the effectiveness and limitations of existing BAL technologies in treating liver failure.
  • To identify unresolved issues and future research directions in the field of artificial liver devices.

Main Methods:

  • Review of clinical reports on BAL applications from key research groups (Demetriou/Rozga, Williams, Gerlach, Strom).
  • Analysis of patient numbers treated with different BAL systems (ranging from 1 to 31 patients).
  • Comparison of BAL systems based on bioreactor design, cell quality/quantity, experimental protocols, and patient selection criteria.

Main Results:

  • BAL systems exhibit considerable heterogeneity, preventing direct comparison of their efficacy.
  • No BAL system has convincingly demonstrated effectiveness in replacing impaired liver function in animal models or clinical settings.
  • The long-term viability and functional stability of cultured hepatocytes in bioreactors remain uncertain.
  • Assessing specific metabolic or detoxifying functions is insufficient to validate overall system effectiveness for complex liver failure.
  • Reported 'successes' often relate to BAL serving as a bridge to liver transplantation, highlighting transplant efficacy rather than BAL benefit.

Conclusions:

  • Current Bioartificial Liver (BAL) systems have not yet proven effective for treating liver failure.
  • Critical research questions regarding cell stability, functional assessment, and system validation persist.
  • BAL technologies may have advanced to clinical application prematurely, lacking sufficient basic science validation.

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