Long-term survivors with artificial liver support in fulminant hepatic failure.
Clinical ability of artificial liver support (ALS) has been improved greatly in recent years which has allowed us to encounter long-term survivors with fulminant hepatic failure (FHF) whose liver function has been almost completely lost. This suggests that application of ALS in patients with FHF gains time while awaiting transplantation as well as time for functional recovery and regeneration of the liver graft following receipt of the graft with marginal function and/or size. Thus, ALS will contribute greatly to extending the indications for liver transplantation and increase the number of patients receiving and benefiting from this treatment. On the other hand, introduction of ALS prolongs the duration of intensive treatment which increases the risk of infection and increases medical costs. In addition, when to discontinue intensive treatment of patients whose level of consciousness is maintained only by ALS is controversial. Thus, further investigation will be needed to establish a consensus on indications for long-term ALS in FHF.
Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
Masakazu
M
Nitta
Hiroyuki
H
Hirasawa
Shigeto
S
Oda
Hidetoshi
H
Shiga
Kazuya
K
Nakanishi
Kenichi
K
Matsuda
Masataka
M
Nakamura
Kennji
K
Yokohari
Takeshi
T
Hirano
Yoh
Y
Hirayama
Takeshi
T
Moriguchi
Eizou
E
Watanabe
D000328:Adult; D005260:Female; D017583:Hemodiafiltration / Q000379:methods; D006501:Hepatic Encephalopathy / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D017093:Liver Failure / Q000503:physiopathology / Q000628:therapy*; D008115:Liver Regeneration; D016031:Liver Transplantation; D019164:Liver, Artificial; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange / Q000295:instrumentation; D017741:Survivors