title: Extracorporeal liver perfusion using human and pig livers for acute liver failure.
abstract: BACKGROUND
  Patients with fulminant hepatic failure (FHF) often die awaiting liver transplantation. Extracorporeal liver perfusion (ECLP) has been proposed as a method of "bridging" such patients to transplantation. We report the largest experience to date of ECLP using human and porcine livers in patients with acute liver failure.
  
  
  METHODS
  Patients with FHF unlikely to survive without liver transplantation were identified. ECLP was performed with human or porcine livers. Patients underwent continuous perfusion until liver transplantation or withdrawal of support. Two perfusion circuits were used: direct perfusion of patient blood through the extracorporeal liver and indirect perfusion with a plasma filter between the patient and the liver.
  
  
  RESULTS
  Fourteen patients were treated with 16 livers in 18 perfusion circuits. Nine patients were successfully "bridged" to transplantation. ECLP stabilized intracranial pressure (ICP) and cerebral perfusion pressure (CPP). Arterial ammonia levels fell from a median of 146 to 83 micromol/liter within 12 hr and this reduction was maintained at least 48 hr. Pig and human ECLP lowered ammonia levels equally. Serum bilirubin levels also fell from a median of 385 to 198 micromol/liter over the first 12 hr but the response was not sustained as well with porcine livers. There was no immunological benefit to using the the filtered perfusion circuit.
  
  
  CONCLUSIONS
  These data demonstrate that ECLP is safe and can provide metabolic support for comatose patients with fulminant hepatic failure for up to 5 days. While labor and resource intensive, this technology is available to centers caring for patients with acute liver failure and deserves wider evaluation and application.
authors: Department of Pediatric Gastroenterology and Nutrition, University of Nebraska Medical Center, Omaha 68198-3285, USA.
authors: S P
authors: SP
authors: Horslen
authors: J M
authors: JM
authors: Hammel
authors: L W
authors: LW
authors: Fristoe
authors: J A
authors: JA
authors: Kangas
authors: D S
authors: DS
authors: Collier
authors: D L
authors: DL
authors: Sudan
authors: A N
authors: AN
authors: Langnas
authors: R S
authors: RS
authors: Dixon
authors: E D
authors: ED
authors: Prentice
authors: B W
authors: BW
authors: Shaw
authors: I J
authors: IJ
authors: Fox
mesh_terms: D000293:Adolescent; D000328:Adult; D000641:Ammonia / Q000097:blood; D000818:Animals; D000888:Antibodies, Anti-Idiotypic / Q000378:metabolism; D001706:Biopsy; D002648:Child; D004730:Endothelium, Vascular / Q000378:metabolism; D005112:Extracorporeal Circulation / Q000379:methods*; D006501:Hepatic Encephalopathy / Q000601:surgery; D006801:Humans; D008099:Liver / Q000473:pathology; D017114:Liver Failure, Acute / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality / Q000473:pathology; D010477:Perfusion / Q000379:methods*; D015996:Survival Rate; D013552:Swine; D014183:Transplantation, Heterologous
chemical_list: D000888:Antibodies, Anti-Idiotypic; C048844:anti-IgG; C044203:anti-IgM; D000641:Ammonia