Advances in bioartificial liver devices

@article{Allen2001AdvancesIB,
  title={Advances in bioartificial liver devices},
  author={J. William Allen and Tarek I. Hassanein and Sangeeta N. Bhatia},
  journal={Hepatology},
  year={2001},
  volume={34}
}
Liver failure is the cause of death for over 30,000 patients each year in the United States alone.When this process occurs in healthy individuals with normal livers, it is termed acute liver failure (ALF). Loss of liver function that complicates chronic liver disease is termed acute-on-chronic liver failure. Liver transplantation is curative for ALF and acute-onchronic liver failure.1-6 Over the years, survival after transplantation has improved with advances in both patient management and… 
Bioartificial liver support devices: historical perspectives
TLDR
The survival of patients excluded from liver transplantation or those with potentially reversible acute hepatitis might be improved with temporary artificial liver support.
Bioengineering of liver assist devices.
TLDR
The authors describe the critical issues involved in bioartificial liver development and discuss their experiences in hepatocyte culture optimization within the context of a microchannel, flat-plate bioart artificial liver device with an internal membrane oxygenator.
Issues in Bioartificial Liver Support Therapy for Acute Liver Failure
TLDR
The clinical efficacy of both AL (detoxification) and BAL (cell-based metabolic support) will be verified in the next 10 years, however, the clinical timing and indication will be different for the two systems: detoxification approaches will be employed earlier in the disease progression and, most likely, for AoCLF while BAL support will be used to support ALF patients andwill be used when the disease continues to progress despite best medical therapy and detoxification.
Artificial Liver Devices and Bioartificial Liver Systems: Current Status
TLDR
The characteristics and the preclinical data of the first bioartificial liver system developed in Korea that is currently under clinical investigation, will be discussed.
Acute liver failure: liver support therapies
TLDR
The therapeutic approach to patients with acute liver failure with the main focus on bioartificial and artificial liver support is summarized and specific and general therapeutic approaches based upon recent advances in the understanding of the pathophysiology of acute Liver failure are described.
Liver replacement therapy.
The realization of a support device able to effectively replace liver function in patients with hepatic failure has thus far been an elusive goal. The complexity of liver metabolic, synthetic,
Clinical Application of Bioartificial Liver Support Systems
TLDR
Bioartificial liver therapy for bridging patients with ALF to liver transplantation or liver regeneration is promising, and its clinical value awaits further improvement of BAL devices, replacement of hepatocytes of animal origin by human hepatocytes, and assessment in controlled clinical trials.
Bioartificial liver systems: why, what, whither?
TLDR
A novel bioreactor design is described that closely mimics the native liver cell environment and is easily scaled from microscopic (<1 ml cells) to clinical size, while maintaining the same local cell environment throughout theBioreactor.
Artificial and bioartificial liver support.
TLDR
Further randomized controlled trials will be necessary to determine the role of artificial and bioartificial liver support devices in the treatment of patients with ALF.
Bio-artificial liver: An advanced therapy for liver failure
TLDR
Bioreactors, when combined with artificial components, becomes a pragmatic approach for future treatment of liver failure and different bio artificial liver systems are being investigated clinically on the basis of their capacity to provide and replace most of the liver functions.
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References

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Clinical experience with a bioartificial liver in the treatment of severe liver failure. A phase I clinical trial.
TLDR
A bioartificial liver to treat patients with severe liver failure until they can be either transplanted or recover spontaneously and the authors' clinical experience with the BAL has yielded encouraging results.
Indications for orthotopic liver transplantation in fulminant liver failure
TLDR
The results of orthotopic liver transplantation in fulminant liver failure have steadily improved over recent years, yielding a good prognosis for certain groups of patients who previously had unacceptably high mortality.
Liver transplantation in Europe for patients with acute liver failure.
TLDR
In selected patients, auxiliary partial orthotopic liver transplantation may be a therapeutic option, with the potential for native liver generation and eventual immunosuppression withdrawal in approximately two-thirds of patients.
Early clinical experience with a hybrid bioartificial liver.
TLDR
BAL treatment is safe and beneficial and can be successfully used as a 'bridge' to transplantation.
Extracorporeal liver support. Application to fulminant hepatic failure.
TLDR
Theoretical and practical aspects of biologically active devices using FHF as a paradigm of liver disease are reviewed and a device that provides liver support during the critical stages of FHF might negate the need for transplant altogether if the liver were able to regenerate.
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TLDR
Two-stage total hepatectomy with temporary portocaval shunt, and subsequent liver transplantation can be a life-saving approach in patients most likely to die of the sequelae of advanced liver or graft necrosis or exsanguination that cannot be controlled by conventional treatment or immediate liver transplation.
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TLDR
It is concluded that liver transplantation remains the therapeutic choice for fulminant hepatic failure in children and early referral and closer follow-up is necessary for timely admission to liver transplant centers to enable screening and proper preparation of these patients for liver transplants.
A Bioartificial Liver to Treat Severe Acute Liver Failure
TLDR
The bioartificial liver developed by the authors is safe and serves as an effective “bridge” to liver transplant in some patients and in vivo in experimental animals with liver failure.
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TLDR
Overall results are comparable to those achieved for less emergent non-neoplastic indications in this same age group and ventilator dependency prior to transplantation is the strongest predictor of ultimate survival, followed by recipient age.
The bioartificial liver: state-of-the-art.
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TLDR
In extensive animal studies using a well-characterized animal model fulminant hepatic failure (FHF), it is demonstrated that the UCLA-BAL system had superior diffusion surface area and a higher capacity for hepatocytes compared to conventional capillary hollow-fiber based BAL devices.
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