Extracorporeal liver support based on primary human liver cells and albumin dialysis--treatment of a patient with primary graft non-function.
METHODS
Following liver transplantation, a 26-year old female suffered from primary non-function of the transplant. The patient was subsequently treated with a modular extracorporeal liver support concept until a suitable organ became available. A bioreactor was charged with human liver cells, obtained from a discarded cadaveric graft (470 g, viability: 60%). The bioreactor was integrated into an extracorporeal circuit with continuous single pass albumin dialysis and continuous veno-venuous hemodiafiltration for detoxification and fluid reduction.


RESULTS
Over the total system application time of 79 h, a significant reduction of the plasma levels of total bilirubin (21.1 mg/dl at start, 10.1 mg/dl at end of therapy) and ammonia (100 versus 22.7 micromol/l) was achieved. During treatment the patient's neurological status significantly improved from coma stage IV to I permitting extubation. Recovery of kidney function with a urine output of 1325 ml/24 h compared to 45 ml/24 h prior to system application, was noted. Over the treatment period, an improvement of coagulation status was observed. Adverse events were absent.


CONCLUSIONS
This first successful clinical treatment of a patient with liver failure suggests that a modular approach combining both primary human liver cell bioreactor technology and detoxification methods is promising.
Sauer
Igor M
IM
Charité--Campus Virchow, Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Medical Faculty of the Humboldt University, Augustenburger Platz 1, 13353 Berlin, Germany. igor.sauer@charite.de
Zeilinger
Katrin
K
Pless
Gesine
G
Kardassis
Dimitrios
D
Theruvath
Tom
T
Pascher
Andreas
A
Goetz
Max
M
Neuhaus
Peter
P
Gerlach
Joerg C
JC
D000328:Adult; D000368:Aged; D019149:Bioreactors; D002102:Cadaver; D005112:Extracorporeal Circulation; D005260:Female; D017583:Hemodiafiltration; D022781:Hepatocytes; D006801:Humans; D017093:Liver Failure / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016031:Liver Transplantation; D008875:Middle Aged; D006435:Renal Dialysis; D012709:Serum Albumin / Q000008:administration & dosage*
D012709:Serum Albumin