Development and perspectives of perfusion treatment for liver failure.
To treat patients with severe liver failure, liver transplantation and blood purification therapy, including plasmapheresis, hemodiafiltration, and bioartificial liver support, are available. The two mainstream systems developed for bioartificial liver support are extracorporeal whole liver perfusion (ECLP) and the bioreactor system (BIS). We developed a method of cross-plasma perfusion, in which plasma is exchanged between the blood circuit of the patient and that of a hepatic functioning unit, through which immunologically free whole human blood is perfused. From the aspects of efficacy and epidemic safety, the best system of bioartificial liver support for clinical use is considered to be ECLP in cross-plasma perfusion. In opposition, a social antagonist for zoonosis has consistently been raised, with controversy surrounding the use of xenogeneic organs for human treatment, which might be final obstacle. It is possible that the combination therapy of hemodiafiltration and the administration of human serum albumin and anticoagulant factors, which minimizes the economic and medical resource costs through the development of transgenic livestock that secrete human pharmaceuticals systemically, will become a more desirable and practical treatment for patients with severe liver failure.
Division of Artificial Organs and Transplantation, Department of Surgery, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan.
Katsutoshi
K
Naruse
Hiroshi
H
Nagashima
Yasuyuki
Y
Sakai
Norihiro
N
Kokudo
Masatoshi
M
Makuuchi
D000818:Animals; D005112:Extracorporeal Circulation / Q000379:methods; D006801:Humans; D017093:Liver Failure / Q000601:surgery*; D019164:Liver, Artificial; D010477:Perfusion / Q000379:methods