Clinical application of bioartificial liver support systems.
OBJECTIVE
To review the present status of bioartificial liver (BAL) devices and their obtained clinical results.


BACKGROUND
Acute liver failure (ALF) is a disease with a high mortality. Standard therapy at present is liver transplantation. Liver transplantation is hampered by the increasing shortage of organ donors, resulting in high incidence of patients with ALF dying on the transplantation waiting list. Among a variety of liver assist therapies, BAL therapy is marked as the most promising solution to bridge ALF patients to liver transplantation or to liver regeneration, because several BAL systems showed significant survival improvement in animal ALF studies. Until today, clinical application of 11 different BAL systems has been reported.


METHODS
A literature review was performed using MEDLINE and additional library searches. Only BAL systems that have been used in a clinical trial were included in this review.


RESULTS
Eleven BAL systems found clinical application. Three systems were studied in a controlled trial, showing no significant survival benefits, in part due to the insufficient number of patients included. The other systems were studied in a phase I trial or during treatment of a single patient and all showed to be safe. Most BAL therapies resulted in improvement of clinical and biochemical parameters.


CONCLUSIONS
Bioartificial liver therapy for bridging patients with ALF to liver transplantation or liver regeneration is promising. Its clinical value awaits further improvement of BAL devices, replacement of hepatocytes of animal origin by human hepatocytes, and assessment in controlled clinical trials.
Department of Surgery (Surgical Laboratory), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Maarten Paul
MP
van de Kerkhove
Ruurdtje
R
Hoekstra
Robert A F M
RA
Chamuleau
Thomas M
TM
van Gulik
D016638:Critical Illness; D005112:Extracorporeal Circulation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017093:Liver Failure / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods; D019164:Liver, Artificial; D008297:Male; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014850:Waiting Lists