A bioartificial liver to treat severe acute liver failure.
OBJECTIVE
To test the safety and efficacy of a bioartificial liver support system in patients with severe acute liver failure.


BACKGROUND
The authors developed a bioartificial liver using porcine hepatocytes. The system was tested in vitro and shown to have differentiated liver functions (cytochrome P450 activity, synthesis of liver-specific proteins, bilirubin synthesis, and conjugation). When tested in vivo in experimental animals with liver failure, it gave substantial metabolic and hemodynamic support.


METHODS
Seven patients with severe acute liver failure received a double lumen catheter in the saphenous vein; blood was removed, plasma was separated and perfused through a cartridge containing 4 to 6 x 10(9) porcine hepatocytes, and plasma and blood cells were reconstituted and reinfused. Each treatment lasted 6 to 7 hours.


RESULTS
All patients tolerated the procedure(s) well, with neurologic improvement, decreased intracranial pressure (23.0 +/- 2.3 to 7.8 +/- 1.7 mm Hg; p < 0.005) associated with an increase in cerebral perfusion pressure, decreased plasma ammonia (163.3 +/- 21.3 to 112.2 +/- 9.8 microMoles/L; p < 0.01), and increased encephalopathy index (0.60 +/- 0.17 to 1.24 +/- 0.22; p < 0.03). All patients survived, had a liver transplant, and were discharged from the hospital.


CONCLUSIONS
This bioartificial liver is safe and serves as an effective "bridge" to liver transplant in some patients.
Rozga
J
J
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Podesta
L
L
LePage
E
E
Morsiani
E
E
Moscioni
A D
AD
Hoffman
A
A
Sher
L
L
Villamil
F
F
Woolf
G
G
McGrath
M
M
D000293:Adolescent; D000328:Adult; D000596:Amino Acids / Q000097:blood; D001187:Artificial Organs; D002648:Child; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D007427:Intracranial Pressure; D008099:Liver / Q000166:cytology; D017114:Liver Failure, Acute / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged
D000596:Amino Acids