Liver support technology – an update

@article{Rozga2006LiverST,
  title={Liver support technology – an update},
  author={Jacek Rozga},
  journal={Xenotransplantation},
  year={2006},
  volume={13}
}
  • J. Rozga
  • Published 1 September 2006
  • Medicine
  • Xenotransplantation
Abstract:  Background:  Currently, there is no direct treatment for hepatic failure, and patients must receive a transplant or endure prolonged hospitalization, with significant morbidity and mortality. Because of the scarcity of donor organs, liver support strategies are being developed with the aim of either supporting patients with borderline functional liver cell mass until an appropriate organ becomes available for transplantation or until their livers recover from injury. 
Extracorporeal Liver Support in Patients with Acute Liver Failure.
T reatment options for patients with acute liver failure (ALF) are limited to supportive care and liver transplantation. The shortage of donor grafts poses a severe challenge in treating the number
Artificial liver support systems in the management of complications of cirrhosis.
TLDR
Better understanding of the pathophysiology of ACLF, further development of the current systems, and their evaluation in appropriately controlled clinical studies are necessary to translate their application to improvement in outcome of patients with ACLF.
The promise of artificial liver replacement.
TLDR
This manuscript reviews the significant clinical findings of ALF, as well as, the non-biologic liver support systems and the bioartificial liver devices that have been clinically tested to support patients with this disease.
New Strategies for Acute Liver Failure: Focus on Xenotransplantation Therapy.
TLDR
Xenotransplant of adult hepatocytes of transgenic pigs with less immunogenic cells associated with new immunosuppressor strategies has allowed the development of this area, and some of the newly developed techniques might have clinical benefits as future treatment for ALF.
Liver dialysis in acute-on-chronic liver failure: current and future perspectives
TLDR
Removal of hepatotoxic metabolites and inhibitors of hepatic regeneration by liver dialysis, a non-cell-based hepatic support, could help to provide a suitable microenvironment and support the failing liver.
Barriers to the successful treatment of liver disease by hepatocyte transplantation.
TLDR
Use of whole liver transplantation to treat liver-based metabolic disorders is limited by a severe shortage of donors and by the risks to the recipient associated with major surgery.
Hepatic assist devices: Will they ever be successful?
TLDR
Goals for making a clinically useful BAL are proposed, with attention to systems biology and potential sources of hepatocytes.
Acute-on-chronic liver failure: extracorporeal liver assist devices
TLDR
Liver support systems are safe and well tolerated when used in management of patients with ACLF and should continue in controlled clinical trials to explore their role in bridging patients to liver transplantation or recovery in well defined patient groups.
INCREASING AND ASSESSING THE IMPACT OF PATIENT CHOICE IN LIVER TRANSPLANTATION
TLDR
This dissertation discusses three models that are related to ESLD and evaluates the effects of multiple listing on every wait-listed patient, rather than on a single patient, and considers a hypothetical system in which an internal LAD is available.
Liver Assist Devices for Liver Failure
TLDR
Several clinical and randomized trials have conflicting results on the survival of the patients with acute liver failure (ALF), and the ideal liver support system still seems a far-off goal.
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 81 REFERENCES
Advances in bioartificial liver devices
TLDR
Recent advances in liver biology and bioengineering that have impacted the field are highlighted and important issues include choice of cellular components, stabilization of hepatocyte phenotype, bioreactor design, regulation and safety, and clinical trials.
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.
The Management of Fulminant Hepatic Failure
TLDR
Fulminant hepatic failure is a clinical syndrome characterized by the appearance of sudden marked impairment of liver cell function with hepatic encephalopathy, resulting from acute necrosis or dysfunction of a large portion of liver parenchyma.
THE USE OF ABO‐INCOMPATIBLE GRAFTS IN LIVER TRANSPLANTATION: A LIFE‐SAVING PROCEDURE IN HIGHLY SELECTED PATIENTS
TLDR
The results indicate that the use of ABO-incompatible liver grafts is a life-saving procedure in patients with life-threatening acute liver failure, but at a high price.
A Novel Plasma Filtration Therapy for Hepatic Failure: Preclinical Studies
TLDR
Treatment of pigs with experimentally‐induced fulminant hepatic failure is safe and effective in extending survival time and arresting brain swelling and Selective plasma filtration is a novel approach to blood purification therapy designed to reduce the level of circulating toxins of hepatic and renal failure.
Control of cerebral oedema by total hepatectomy and extracorporeal liver support in fulminant hepatic failure
TLDR
An 18-year-old woman with paracetamol-induced FHF, who was treated by total hepatectomy, hypothermia, plasma exchange, and extracorporeal liver support, is described, which resulted in reversal of severe neurological dysfunction, normalisation of intracranial pressure, and decreased serum ammonia.
Reversal of fulminant hepatic failure using an extracorporeal liver assist device
TLDR
A device consisting of a highly differentiated human liver cell line cultured in a hollow fiber cartridge is capable of supporting dogs with acetaminopheninduced fulminant hepatic failure for a period long enough for their own livers to resume function, allowing recovery of hepatocytes that would otherwise have lysed.
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.
Plasmapheresis in Acute Liver Failure
A series of 9 patients with acute hepatic failure and Grade IV hepatic coma received daily plasmapheresis until they recovered or death ensued. Of the nine, seven (77%) showed an improvement in coma
Prospective, Randomized, Multicenter, Controlled Trial of a Bioartificial Liver in Treating Acute Liver Failure
TLDR
This is the first prospective, randomized, controlled trial of an extracorporeal liver support system, demonstrating safety and improved survival in patients with fulminant/subfulminant hepatic failure.
...
1
2
3
4
5
...