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Rajiv Jalan - One of the best experts on this subject based on the ideXlab platform.

  • Liver Support Systems
    Complications of Cirrhosis, 2020
    Co-Authors: Mansoor Bangash, Banwari Agarwal, Rajiv Jalan
    Abstract:

    The multifunctional and complex nature of the Liver is reflected in the severity of physiological derangement that occurs in Liver failure. Effective treatment modalities outside of Liver transplantation are lacking; however, the shortage of suitable organs for transplantation, the high mortality of Liver failure without transplantation, and the morbidity and mortality associated with transplantation have provided the impetus to develop an effective Liver Support device. The quest for such device(s) has been ongoing for more than 50 years, focusing on approaches based on cell-based (bio-artificial), cell-free (artificial), or a combination of the two systems. Bio-artificial devices aim to replace the whole gamut of Liver functions (synthesis, biotransformation, detoxification, and excretion) through the use of cultured hepatocytes, whereas artificial devices predominantly employ blood purification and detoxification strategy through processes targeting albumin-based dialysis and the use of adsorbents. While the safety of these systems, and their capacity to achieve significant clearance of toxins, has been proven in animal and human studies, the evidence of mortality benefit is yet to be established. This chapter describes currently available Liver Support systems, their operational characteristics, limitations, evidence of clinical efficacy, and prospects for future development.

  • Extracorporeal Liver Support devices in the ICU
    Oxford Medicine Online, 2020
    Co-Authors: Rajiv Jalan, Banwari Agarwal
    Abstract:

    Liver failure is common and carries high morbidity and mortality. Liver transplantation (LT) is the only definitive treatment available performed as an emergency in acute Liver failure and electively for chronic Liver disease. In the last 50 years, a number of extracorporeal Liver Support devices and modifications have emerged , some of them purely mechanical in nature aimed at detoxification, while others are cell based systems possessing bio-transformational capability. Mechanical devices are mainly based on albumin dialysis, albumin being a key transporter protein that is severely deficient and irreversibly destroyed in Liver diseases. Despite a sound scientific rationale and good safety profile, none of the currently available devices have shown enough promise to be incorporated in routine clinical practice, their use being limited to specific clinical situations. This chapter describes currently available devices, their operational characteristics, current evidence of their utility and limitation, and the future developments in the field of extracorporeal Liver Support.

  • extracorporeal Liver Support devices for listed patients
    Liver Transplantation, 2016
    Co-Authors: Vanessa Stadlbauer, Rajiv Jalan
    Abstract:

    An alternative to Liver transplantation for patients with Liver failure remains an unmet need. In acute Liver failure, the ideal extracorporeal Liver Support device (ELSD) would replace the functions of the failing Liver in order to permit spontaneous recovery, given the incredible regenerative potential of the Liver, negating the need for transplantation. In acute-on-chronic Liver failure, an ELSD would ideally Support hepatic function until a recovery to Liver function before acute decompensation or until Liver transplantation. In decompensated cirrhosis, an ELSD could again be used to Support hepatic function until transplant. In addition, ELSDs may have the potential to treat the multiorgan failure that accompanies Liver failure including hepatic encephalopathy, renal failure, and immune dysfunction or indeed potential to promote Liver regeneration. Creation of an extracorporeal bioartificial Liver able to completely replace Liver function remains an unmet need. This review will describe a number of technologies suitable for clinical trials in humans, which have resulted from decades of engineering and biological research to develop a bioreactor able to adequately sustain functional hepatocytes. In addition, this review will describe artificial Liver Support devices that are primarily designed to replace the detoxifying functions of the Liver and will consider the current data available or studies required to Support their use in Liver failure patients on the transplant waiting list. Liver Transplantation 22 839–848 2016 AASLD.

  • Extracorporeal Liver Support
    Blood Purification, 2012
    Co-Authors: P Leckie, Andrew Davenport, Rajiv Jalan
    Abstract:

    Mortality of patients with Liver failure remains unacceptably high. As the Liver has an enormous potential to regenerate, extracorporeal Liver Support devices may allow patients with Liver failure to be bridged to recovery. Alternatively, Liver assist may allow patients with advanced Liver disease to be managed until a suitable organ for transplant is available. Current approaches to Liver Support include the use of biological devices that contain hepatocytes and those that function as detoxification devices, and artificial Liver Support systems. This review describes the current state of the art and existing data on the use of these devices to treat patients with Liver failure.

  • Acute Liver failure: Liver Support therapies.
    Current Opinion in Critical Care, 2007
    Co-Authors: Vanessa Stadlbauer, Rajiv Jalan
    Abstract:

    PURPOSE OF REVIEW: We summarize the therapeutic approach to patients with acute Liver failure with the main focus on bioartificial and artificial Liver Support. We also describe specific and general therapeutic approaches based upon recent advances in the understanding of the pathophysiology of acute Liver failure. RECENT FINDINGS: Bioartificial Liver Support systems use hepatocytes in an extracorporeal device connected to the patient's circulation. Artificial Liver Support is intended to remove protein-bound toxins and water-soluble toxins without providing synthetic function. Both systems improve clinical and biochemical parameters and can be applied safely to patients. Although bioartificial Liver-assist devices have not been shown to improve the survival of patients with acute Liver failure, further development is underway. Artificial Liver Support systems have been shown to alter several pathophysiological mechanisms involved in the development of acute Liver failure but survival data are still limited. SUMMARY: Mortality in patients with acute Liver failure is still unacceptably high. The most effective treatment, Liver transplantation, is a limited resource and so other therapeutic options to bridge patients to recovery or stabilization have to be considered. Better understanding of the pathophysiology of acute Liver failure and device development is necessary to achieve the elusive goal of effective extracorporeal Liver assist.

Scott L Nyberg - One of the best experts on this subject based on the ideXlab platform.

  • Acute Liver Failure and Bioartificial Liver Support
    2020
    Co-Authors: Harvey S. Chen, Jian Yang, Scott L Nyberg
    Abstract:

    Abstract Acute Liver failure (ALF) is a severe disease that can occur in healthy individuals. The current definition of ALF is acute Liver injury associated with coagulopathy and altered mental status for less than 26 weeks with no prior history of Liver disease. Even with Liver transplant and modern intensive care, mortality is still as high as 30%. There are many causes for ALF, with acetaminophen overdose being the most common. Currently, Liver transplantation is the most definitive treatment for ALF. However, with numerous disadvantages of Liver transplantation, such as organ shortage and requirement of life-long immunosuppression, alternative therapies have been sought after by researchers. Liver Support systems are one of the most studied alternative therapies, and many of them have reached clinical trial stage. Liver Support systems can be further categorized into artificial and bioartificial Support systems; bioartificial systems incorporate active hepatocytes to provide further Liver function Support. Currently, many Liver Support systems have been studied but none of them showed unequivocal survival benefit, and none of them are FDA-approved. One of the main aims of future studies is to develop a reliable method to mass produce hepatocytes for therapy and research purposes.

  • Bridging the gap: advances in artificial Liver Support.
    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation S, 2020
    Co-Authors: Scott L Nyberg
    Abstract:

    1. The goals of Liver Support therapy include the following: To provide detoxification and synthetic function during Liver failure. To remove or reduce the production of proinflammatory cytokines to correct the systemic inflammatory response of Liver failure. To stimulate the regeneration of the injured Liver and increase the likelihood of spontaneous recovery. 2. There is a large unmet need for a Liver Support device because of the shortage of organs for Liver transplantation and the risks of major surgery. 3. Liver Support devices can be divided into 2 groups: purely mechanical artificial devices and cell-based bioartificial devices. Both provide detoxification, but bioartificial Liver devices provide the option of synthetic function and biotransformation activities that are not possible with a purely mechanical device. 4. An abundant high-quality supply of human hepatocytes is not currently available for Liver cell therapy. However, such a supply is essential for successful bioartificial Liver therapy. Novel options are under development for the unlimited production of high-quality human hepatocytes.

  • bridging the gap advances in artificial Liver Support
    Liver Transplantation, 2012
    Co-Authors: Scott L Nyberg
    Abstract:

    Key Points 1. The goals of Liver Support therapy include the following: • To provide detoxification and synthetic function during Liver failure. • To remove or reduce the production of proinflammatory cytokines to correct the systemic inflammatory response of Liver failure. • To stimulate the regeneration of the injured Liver and increase the likelihood of spontaneous recovery. 2. There is a large unmet need for a Liver Support device because of the shortage of organs for Liver transplantation and the risks of major surgery. 3. Liver Support devices can be divided into 2 groups: purely mechanical artificial devices and cell-based bioartificial devices. Both provide detoxification, but bioartificial Liver devices provide the option of synthetic function and biotransformation activities that are not possible with a purely mechanical device. 4. An abundant high-quality supply of human hepatocytes is not currently available for Liver cell therapy. However, such a supply is essential for successful bioartificial Liver therapy. Novel options are under development for the unlimited production of high-quality human hepatocytes. Liver Transpl, 2012. © 2012 AASLD.

  • artificial and bioartificial Liver Support
    Seminars in Liver Disease, 2008
    Co-Authors: Travis J Mckenzie, Joseph B Lillegard, Scott L Nyberg
    Abstract:

    Acute Liver failure (ALF) is a widespread problem with an unfavorable prognosis. Currently, Liver transplantation is the only direct means of treatment for patients in ALF. Due to the scarcity of donor organs, Liver Support technologies are being developed and clinically tested with the intent of Supporting a patient in ALF until the patient regains native Liver function or until a donor organ becomes available. Two major categories of devices are currently being tested. Artificial Liver Support is purely mechanical, including albumin dialysis. Bioartificial devices contain cellular material. No single system has reproducibly demonstrated improvement in patient mortality. However, with the advent of new technology and cell acquisition techniques, further randomized controlled trials will be necessary to determine the role of artificial and bioartificial Liver Support devices in the treatment of patients with ALF.

  • Hepatocyte culture systems for artificial Liver Support: Implications for critical care medicine (bioartificial Liver Support)
    Critical Care Medicine, 1992
    Co-Authors: Scott L Nyberg, Russell A. Shatford, Wei Shou Hu, William D. Payne, Frank B. Cerra
    Abstract:

    ObjectiveThe primary purpose of this review article is to familiarize critical care practitioners with newly developing techniques of hybrid artificial Liver Support. Implantable and extra-corporeal hepatocyte culture systems are emphasized based on their current experimental and clinical status.Dat

Igor M. Sauer - One of the best experts on this subject based on the ideXlab platform.

  • Extracorporeal Liver Support: porcine or human cell based systems?
    International Journal of Artificial Organs, 2020
    Co-Authors: Jörg C Gerlach, Gesine Pless, Igor M. Sauer, Katrin Zeilinger, T. Mieder, Goetz Naumann, A. Grunwald, G. Holland, Joerg Vienken
    Abstract:

    Initial results of the clinical use of primary porcine Liver cells for extracorporeal Liver Support are being reviewed as the cell source is controversial. According to Eurotransplant data 20 -25% of explanted donor Livers are not transplanted, due to factors such as steatosis or cirrhosis. This number corresponds to the number of patients with acute Liver failure who require bridging therapy to transplantation. Primary human Liver cells from transplant discards can be isolated, purified and maintained in bioreactors and provide an alternative for cell-based extracorporeal Liver Support therapy. A four-compartment bioreactor enables recovery from preservation and isolation injury in a three-dimensional network of interwoven capillary membranes with integrated oxygenation, rendering the Liver cells from these discarded donor organs viable for clinical utilization. Patient contact with additional animal-derived biomatrix and fetal calf serum can be avoided. The initiation of an in vitro cultivation phase allows cell stabilization, quality control, and immediate availability of a characterized system without cryopreservation. The hypothesis of this paper is that with appropriate logistics and four-compartment bioreactor technology, cells from human Liver transplant discards can serve the demand for cell-based therapy, including extracorporeal Liver Support.

  • Liver Support strategies cutting edge technologies
    Nature Reviews Gastroenterology & Hepatology, 2014
    Co-Authors: Benjamin Struecker, Nathanael Raschzok, Igor M. Sauer
    Abstract:

    This Review describes advances in artificial and bioartificial Liver Support systems and current developments. The evolving field of hepatocyte transplantation as a less invasive alternative to whole-organ transplantation is also reviewed, and a detailed overview of cutting-edge hepatic tissue engineering is included. Challenges and opportunities of the different approaches are analysed with respect to clinical relevance, as well as basic science concerns.

  • Extracorporeal Liver Support
    Management of Acute Kidney Problems, 2009
    Co-Authors: Gesine Pless, Igor M. Sauer
    Abstract:

    In patients with Liver failure, the accumulation of lipophilic, albumin-bound toxins occurs which cannot be eliminated by standard hemodialysis and hemofiltration techniques. For this purpose (artificial and bioartificial) Liver Support systems were developed. Extracorporeal systems for artificial Liver Support include: Molecular adsorbents recirculating system (MARS) Single-pass albumin dialysis (SPAD) Fractionated plasma separation and adsorption (Prometheus) Selective plasma exchange therapy (SEPET) Extracorporeal systems for bioartificial Liver Support include: Extracorporeal Liver perfusion (ECLP) HepatAssist Extracorporeal Liver-assist device (ELAD) Modular extracorporeal Liver Support system (MELS) Bioartificial Liver of the Academisch Medisch Centrum (AMC-BAL) The MARS, SPAD, and Prometheus systems are available for clinical use and are mostly employed either for bridging the patient to transplant or else for bridging to recovery of Liver function. Positive data exist regarding biochemical efficacy and clinical improvement of certain end points such as hepatic encephalopathy, but adequately powered clinical trials evaluating survival rates are at present lacking.

  • clinical extracorporeal hybrid Liver Support phase i study with primary porcine Liver cells
    Xenotransplantation, 2003
    Co-Authors: Igor M. Sauer, Gesine Pless, M. Kraemer, D Kardassis, K Zeillinger, Andreas Pascher, A Gruenwald, Markus Irgang, G Puhl, J Frank
    Abstract:

    : The objective of this study was to evaluate the feasibility and safety of a hybrid Liver Support system with extracorporeal plasma separation and bioreactor perfusion in patients with acute Liver failure (ALF) who had already fulfilled the criteria for high urgency Liver transplantation (LTx). Eight patients (one male, seven female) were treated in terms of bridging to transplantation. The mean age was 36.5 yr (range 20 to 58). Etiology of Liver failure was drug-related in two patients, hepatitis B infection in three patients, and unknown for three patients. The bioreactors were charged with primary Liver cells from specific pathogen-free pigs. Cell viability varied between 91 and 98%. Continuous Liver Support treatment over a period of 8 to 46 h (mean 27.3 h) was safely performed and well-tolerated by all patients. No complications associated with the therapy were observed during the follow-up period. Thrombocytopenia was considered to be an effect of the plasma separation. Subsequently, all patients were transplanted successfully and were observed over at least 3 yr with an organ and patient survival rate of 100%. Screening of patient's sera for antibodies specific for porcine endogenous retroviruses (PERVs) showed no reactivity – either prior to application of the system, or after extracorporeal treatment. The results encourage us to continue the development of the technology, and further studies appear to be justified. The bioreactor technology has been integrated into a modular extracorporeal Liver Support (MELS) system, combining biologic Liver Support with artificial detoxification technology.

  • Modular Extracorporeal Liver Support
    Artificial Organs, 2002
    Co-Authors: Igor M. Sauer, Jörg C Gerlach
    Abstract:

    : Modular extracorporeal Liver Support (MELS) is an integrative concept for the treatment of hepatic failure with appropriate extracorporeal therapy units tailored to suit the actual clinical needs of each patient. The CellModule is a specific bioreactor charged with primary human Liver cells harvested from human donor Livers found to be unsuitable for transplantation due to steatosis, cirrhosis, or traumatic injury. The DetoxModule enables albumin dialysis for the removal of albumin-bound toxins, reducing the biochemical burden of the Liver cells and replacing the bile excretion of hepatocytes in the bioreactor. A DialysisModule for continuous venovenous hemofiltration can be added to the system if required in hepatorenal syndrome.

Vanessa Stadlbauer - One of the best experts on this subject based on the ideXlab platform.

  • extracorporeal Liver Support devices for listed patients
    Liver Transplantation, 2016
    Co-Authors: Vanessa Stadlbauer, Rajiv Jalan
    Abstract:

    An alternative to Liver transplantation for patients with Liver failure remains an unmet need. In acute Liver failure, the ideal extracorporeal Liver Support device (ELSD) would replace the functions of the failing Liver in order to permit spontaneous recovery, given the incredible regenerative potential of the Liver, negating the need for transplantation. In acute-on-chronic Liver failure, an ELSD would ideally Support hepatic function until a recovery to Liver function before acute decompensation or until Liver transplantation. In decompensated cirrhosis, an ELSD could again be used to Support hepatic function until transplant. In addition, ELSDs may have the potential to treat the multiorgan failure that accompanies Liver failure including hepatic encephalopathy, renal failure, and immune dysfunction or indeed potential to promote Liver regeneration. Creation of an extracorporeal bioartificial Liver able to completely replace Liver function remains an unmet need. This review will describe a number of technologies suitable for clinical trials in humans, which have resulted from decades of engineering and biological research to develop a bioreactor able to adequately sustain functional hepatocytes. In addition, this review will describe artificial Liver Support devices that are primarily designed to replace the detoxifying functions of the Liver and will consider the current data available or studies required to Support their use in Liver failure patients on the transplant waiting list. Liver Transplantation 22 839–848 2016 AASLD.

  • Clearing of toxic substances: are there differences between the available Liver Support devices?
    Liver International, 2011
    Co-Authors: Peter Krisper, Vanessa Stadlbauer, Rudolf E. Stauber
    Abstract:

    Toxins accumulating in Liver failure split into water solved (e.g. ammonia) and albumin bound substances (e.g. bilirubin). Because the latter cannot be removed by conventional haemodialysis, special Liver Support systems have been developed. The majority of data concerning elimination efficiency exist for the cell-free devices Molecular Adsorbent Recirculating System (MARS) and Prometheus, as they have been commercially available in Europe since many years. Overall, Prometheus provides higher clearances for most Liver toxins, especially if they are tightly albumin bound. However, for bile acids and cytokines no such differences could be found. Single pass albumin dialysis (SPAD) can be assumed to be equally effective as MARS. None of the bioartificial Liver Support systems being developed is on the market today and published clearance data are scarce. In general, clearance efficiency for albumin bound substances is relatively low in all systems currently available. Besides optimizing biocompatibility and selectivity, future technologies should also focus on improved detoxification efficiency of Liver Support devices.

  • Role of artificial Liver Support in hepatic encephalopathy
    Metabolic Brain Disease, 2008
    Co-Authors: Vanessa Stadlbauer, Gavin Wright, Rajkumar Jalan
    Abstract:

    Hepatic encephalopathy (HE) refers to the reversible neuropsychiatric disorders observed in acute Liver failure and as a complication of cirrhosis and/or portal hypertension. This review aims to describe the pathophysiology of HE, the rationale for the use of artificial Liver Support in the treatment of HE, the different concepts of artificial Liver Support and the results obtained. Ammonia has been considered central to its pathogenesis but recently an important role for its interaction with inflammatory responses and auto-regulation of cerebral hemodynamics has been suggested. Artificial Liver Support might be able to decrease ammonia and modulate inflammatory mediators and cerebral hemodynamics. Bioartificial Liver Support systems use hepatocytes in an extracorporeal device connected to the patient’s circulation. Artificial Liver Support is intended to remove protein-bound toxins and water-soluble toxins without providing synthetic function. Both systems improve clinical and biochemical parameters and can be applied safely to patients. Clinical studies have shown that artificial Liver Support, especially albumin dialysis, is able to improve HE in acute and acute-on-chronic Liver failure. Further studies are required to better understand the mechanism, however, artificial Liver Support can be added to the therapeutic bundle in treating HE.

  • Acute Liver failure: Liver Support therapies.
    Current Opinion in Critical Care, 2007
    Co-Authors: Vanessa Stadlbauer, Rajiv Jalan
    Abstract:

    PURPOSE OF REVIEW: We summarize the therapeutic approach to patients with acute Liver failure with the main focus on bioartificial and artificial Liver Support. We also describe specific and general therapeutic approaches based upon recent advances in the understanding of the pathophysiology of acute Liver failure. RECENT FINDINGS: Bioartificial Liver Support systems use hepatocytes in an extracorporeal device connected to the patient's circulation. Artificial Liver Support is intended to remove protein-bound toxins and water-soluble toxins without providing synthetic function. Both systems improve clinical and biochemical parameters and can be applied safely to patients. Although bioartificial Liver-assist devices have not been shown to improve the survival of patients with acute Liver failure, further development is underway. Artificial Liver Support systems have been shown to alter several pathophysiological mechanisms involved in the development of acute Liver failure but survival data are still limited. SUMMARY: Mortality in patients with acute Liver failure is still unacceptably high. The most effective treatment, Liver transplantation, is a limited resource and so other therapeutic options to bridge patients to recovery or stabilization have to be considered. Better understanding of the pathophysiology of acute Liver failure and device development is necessary to achieve the elusive goal of effective extracorporeal Liver assist.

Jacek Rozga - One of the best experts on this subject based on the ideXlab platform.

  • Liver Support technology – an update
    Xenotransplantation, 2006
    Co-Authors: Jacek Rozga
    Abstract:

    :  Background:  Currently, there is no direct treatment for hepatic failure, and patients must receive a transplant or endure prolonged hospitalization, with significant morbidity and mortality. Because of the scarcity of donor organs, Liver Support strategies are being developed with the aim of either Supporting patients with borderline functional Liver cell mass until an appropriate organ becomes available for transplantation or until their Livers recover from injury. Methods:  A literature review was performed using MEDLINE and library searches. Only major blood detoxification/purification devices and cell-based techniques are included in this review. Results:  Currently, a number of blood purification systems and devices utilizing viable Liver cells are in various stages of clinical development. Non-biological systems include plasma exchange, albumin dialysis, hemo(dia)filtration, and sorbent-based devices (charcoal, resin). These systems are able to remove toxins of hepatic failure, and their utility is limited by their inability to provide missing Liver-specific functions. In contrast, hepatocyte-based devices are able to provide whole Liver functions, including detoxification, biosynthesis, and biotransformation. Molecular adsorbent recycling system (MARS) blood detoxification system has been tested in thousands of patients, but additional well-conducted controlled studies are warranted to better define the role of MARS® in the treatment of patients with acute hepatic failure and acute exacerbation of chronic Liver disease. HepatAssist™ was tested in a phase II/III controlled clinical trial that demonstrated safety and proof of concept for use of biological Liver Support systems to improve patient survival in acute hepatic failure. Conclusions:  Developing an effective Liver assist technology has proven difficult, because of the complexity of Liver functions that must be replaced, as well as heterogeneity of the patient population. Non-biological systems may have a role in the treatment of specific forms of Liver failure where the primary goal is to provide blood detoxification/purification. Biological systems appear to be useful in treating Liver failure where the primary objective is to provide whole Liver functions which are impaired or lost. It is suggested that there will be a role for hybrid Liver Support systems that offer Liver cell therapy and various forms of blood purification (sorption, hemofiltration and diafiltration) to treat patients with specific forms of Liver failure at various stages of their illness.

  • Liver Support technology an update
    Xenotransplantation, 2006
    Co-Authors: Jacek Rozga
    Abstract:

    :  Background:  Currently, there is no direct treatment for hepatic failure, and patients must receive a transplant or endure prolonged hospitalization, with significant morbidity and mortality. Because of the scarcity of donor organs, Liver Support strategies are being developed with the aim of either Supporting patients with borderline functional Liver cell mass until an appropriate organ becomes available for transplantation or until their Livers recover from injury. Methods:  A literature review was performed using MEDLINE and library searches. Only major blood detoxification/purification devices and cell-based techniques are included in this review. Results:  Currently, a number of blood purification systems and devices utilizing viable Liver cells are in various stages of clinical development. Non-biological systems include plasma exchange, albumin dialysis, hemo(dia)filtration, and sorbent-based devices (charcoal, resin). These systems are able to remove toxins of hepatic failure, and their utility is limited by their inability to provide missing Liver-specific functions. In contrast, hepatocyte-based devices are able to provide whole Liver functions, including detoxification, biosynthesis, and biotransformation. Molecular adsorbent recycling system (MARS) blood detoxification system has been tested in thousands of patients, but additional well-conducted controlled studies are warranted to better define the role of MARS® in the treatment of patients with acute hepatic failure and acute exacerbation of chronic Liver disease. HepatAssist™ was tested in a phase II/III controlled clinical trial that demonstrated safety and proof of concept for use of biological Liver Support systems to improve patient survival in acute hepatic failure. Conclusions:  Developing an effective Liver assist technology has proven difficult, because of the complexity of Liver functions that must be replaced, as well as heterogeneity of the patient population. Non-biological systems may have a role in the treatment of specific forms of Liver failure where the primary goal is to provide blood detoxification/purification. Biological systems appear to be useful in treating Liver failure where the primary objective is to provide whole Liver functions which are impaired or lost. It is suggested that there will be a role for hybrid Liver Support systems that offer Liver cell therapy and various forms of blood purification (sorption, hemofiltration and diafiltration) to treat patients with specific forms of Liver failure at various stages of their illness.

  • bioartificial Liver Support
    Journal of Hepato-biliary-pancreatic Surgery, 2001
    Co-Authors: Jacek Rozga, Achilles A Demetriou
    Abstract:

    Orthotopic Liver transplantation is the only definitive therapy for patients with fulminant hepatic failure (FHF). However, due to shortage of organs, a large number of patients die before a Liver can be procured for transplantation. In FHF the need for a Liver is particularly urgent because of rapid deterioration in the patients' condition with the onset of cerebral edema and intracranial hypertension leading to irreversible brain damage. It is thus necessary to develop an extracorporeal Liver Support system to help maintain patients alive and neurologically intact until an organ becomes available for transplantation. Multiple attempts have been made, ranging from the use of plasma exchange to utilization of charcoal columns and extracorporeal devices loaded with Liver tissue to develop Liver Support systems for treating patients with acute severe Liver failure. None of these systems has achieved wide clinical use, and FHF due to multiple causes continues to be associated with significant morbidity and mortality. In this paper, the authors review the history of extracorporeal Liver Support for acute Liver failure and discuss their experience with a hollow fiber bioartificial Liver Support system utilizing porcine hepatocytes in the treatment of patients with acute Liver failure.