Document Detail


Treatment of severe liver failure with a bioartificial liver.
MedLine Citation:
PMID:  9616727     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Orthotopic liver transplantation (OLT) is the definitive therapy for severe liver failure. However, many patients die before an organ becomes available, mostly from cerebral edema. To provide temporary liver support, we developed a bioartificial liver (BAL) based on porcine hepatocytes and a charcoal column. Fifty-four consecutive BAL treatments were carried out in three groups of patients: Group I (n = 15) patients presented with FHF were listed for emergent OLT, Group II (n = 3) patients with primary non-function (PNF) of their liver grafts required urgent re-transplantation and Group III (n = 10) patients with acute exacerbation of chronic liver disease were not candidates for OLT. Patients were managed in a critical care unit receiving maximal standard support. Each BAL treatment was conducted for 6 hours. In Group I, all patients showed significant neurologic improvement, intracranial pressure (ICP) decreased and cerebral perfusion pressure (CPP) increased; other significant improvements, included lowered plasma ammonia and liver enzymes and increased glucose. One patient recovered spontaneously without OLT, all other patients were "bridged" to OLT, and recovered. Group II: PNF patients showed similar benefits. Group III: Chronic liver patients demonstrated transient beneficial effects after BAL treatment(s), however, most (n = 8) eventually succumbed to sepsis and multiple organ failure as they were not candidates for OLT; two patients, recovered, later were successfully transplanted and survived. Our clinical experience demonstrates that the BAL can serve as a bridge to OLT in patients with acute liver failure.
Authors:
S C Chen; C Mullon; E Kahaku; F Watanabe; W Hewitt; S Eguchi; Y Middleton; N Arkadopoulos; J Rozga; B Solomon; A A Demetriou
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of the New York Academy of Sciences     Volume:  831     ISSN:  0077-8923     ISO Abbreviation:  Ann. N. Y. Acad. Sci.     Publication Date:  1997 Dec 
Date Detail:
Created Date:  1998-06-24     Completed Date:  1998-06-24     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7506858     Medline TA:  Ann N Y Acad Sci     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  350-60     Citation Subset:  IM    
Affiliation:
Department of Surgery, Cedars-Sinai Medical Center, UCLA School of Medicine 90048, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Amino Acids / blood
Animals
Child
Female
Hemodynamics
Hepatic Encephalopathy / surgery*
Humans
Liver Function Tests
Liver, Artificial*
Male
Middle Aged
Swine
Transplantation, Heterologous
Treatment Outcome
Chemical
Reg. No./Substance:
0/Amino Acids

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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