Evaluation of effect of hybrid bioartificial liver using end-stage liver disease model.
OBJECTIVE
To study the role of hybrid bioartificial liver (HBL) in clearing proinflammatory cytokines and endotoxin in patients with acute and sub-acute liver failure and the effects of HBL on systemic inflammatory syndrome (SIRS) and multiple organ dysfunction syndrome (MODS).


METHODS
Five cases with severe liver failure (3 acute and 2 subacute) were treated with HBL. The clinical signs and symptoms, total bilirubin (TBIL), serum ammonia, endotoxin TNF-alpha, IL-6 and prothrombin activity (PTA),cholinesterase (CHE) were recorded before, during and after treatment. The end-stage liver disease (MELD) was used for the study.


RESULTS
Two patients were bridged for spontaneous recovery and 1 patient was bridged for OLT successfully. Another 2 patients died on d 8 and d 21. The spontaneous recovery rate was 30.0%. PTA and CHE in all patients were significantly increased (P<0.01), while the serum TBIL, endotoxin, TNF-alpha, IL-6 were decreased. MELD score (mean 43.6) predicted 100% deaths within 3 mo before treatment with HBL. After treatment with HBL, four out of 5 patients had decreased MELD scores (mean 36.6). The MELD score predicted 66% mortalities.


CONCLUSIONS
The proinflammatory cytokines (TNFalpha, IL-6 and endotoxin)can be significantly removed by hybrid bioartificial liver and HBL appears to be effective in blocking SIRS and MODS in patients with acute and sub-acute liver failure. MELD is a reliable measure for predicting short-term mortality risk in patients with end-stage liver disease. The prognostic result also corresponds to clinical outcome.
Liu
Qing
Q
Artificial Liver Treatment and Training Center, Beijing Youan Hospital, Beijing 100054, China. lqlq8@yahoo.com
Duan
Zhong-Ping
ZP
Huang
Chun
C
Zhao
Chun-Hui
CH
D000328:Adult; D004731:Endotoxins / Q000378:metabolism; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000378:metabolism; D017093:Liver Failure / Q000503:physiopathology / Q000628:therapy*; D019164:Liver, Artificial; D008297:Male; D009102:Multiple Organ Failure; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D004731:Endotoxins; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha