Attempts to develop liver support systems for the treatment of patients with liver failure have ranged from use of plasma exchange to utilization of charcoal columns and extracorporeal devices loaded with liver tissue. However, no system has achieved wide clinical use and - in the absence of liver transplantation - severe hepatic failure continues to be associated with significant morbidity and mortality. In this paper, the authors review the current status of liver assist systems and summarize their clinical experience with a xenogeneic cell based-bioartificial liver.
KamlotA., RozgaJ., WatanabeF.Artificial liver support system: an overview. Biotechnol Bioengineer1996; 50: 382–91.
7.
KileyJ.E., PenderJ.C., WelchH.F.Ammonia intoxication treated with hemodialysis. N Engl J Med1958; 259: 1156–61.
8.
SilkD.B.A., TrewbyP.N., ChaseR.A.Treatment of fulminant hepatic failure by polyacrylonitrile-membrane hemodialysis. Lancet1977; II: 1–3.
9.
DenisJ., OpolonP., NusinoviciV.Treatment of encephalopathy during fulminant hepatic failure by haemodialysis with high permeability membrane. Gut1978; 19: 787–93.
10.
OpolonP.. High permeability membrane hemodialysis and hemofiltration in acute hepatic coma-experimental and clinical results. Artif Organs1979; 3: 354–60.
11.
YatzidisH.. A convenient hemoperfusion microapparatus over charcoal for the treatment of endogenous and exogenous intoxifications: its use as an effective artificial kidney. Proc Eur Dial Transplant Assoc1964; 1: 83–7.
12.
GelfandM.C., WinchesterJ.F., KnepshieldJ.H.Biochemical correlates of reversal of hepatic coma with coated charcoal hemoperfusion. Trans Am Soc Artif Intern Organs1978; 24: 239–42.
13.
SmithJ.W., MatsubaraS., HoriuchiT.Sorption-filtration therapy for chronic liver disease: in vitro testing and clinical correlation. ASAIO Trans1982; 28: 215–9.
14.
O'GradyJ.G., GimsonA.E.S., O'BrienC.J.Controlled trials of charcoal hemoperfusion and prognostic factors in fulminant hepatic failure. Gastroenterology1988; 94: 1186–92.
15.
AshS.R.. Hemodiabsorption in the treatment of acute hepatic failure. ASAIO1994; 40: 80–2.
16.
HughesR.D., WilliamsR.. Clinical experience with charcoal and resin hemoperfusion. Semin Liv Dis1986; 6: 164–73.
17.
IsekiJ., TouyamaK., NakagamiK.Plasma adsorption to charcoal and ion exchange resin for treating postoperative hepatic failure. Hepato-Gastroenterology1995; 42: 394–8.
18.
TreyM.B., BurnsD.G., SaundersS.J.. Treatment of hepatic coma by exchange blood transfusion. N Engl J Med1966; 274: 473–81.
19.
BurnellJ.M., DawbornJ.K., EpsteinR.B.Acute hepatic coma treated by crosscirculation or exchange transfusion. N Engl J Med1967; 276: 935–43.
20.
RedekerA.G., YamahiroH.S.. Controlled trial of exchange-transfusion therapy in fulminant hepatitis. Lancet1973; II: 2–6.
21.
KondrupJ., AlmdalT., VilstrupH.High volume plasma exchange in fulminant hepatic failure. Int J Artif Organs1992; 15: 669–76.
22.
MatsubaraS.. Combination of plasma exchange and continuous hemofiltration as temporary metabolic support for patients with acute liver failure. Artif Organs1994; 18: 363–6.
23.
YoshibaM., SekiyamaK., IwamuraY., SugataF.. Development of reliable artificial liver support (ALS)-plasma exchange in combination with hemodiafiltration using high performance membranes. Dig Dis Sci1993; 38: 469–76.
24.
CooperG.N., KarlsonK.E., ClowesG.H.A.Total body washout and exchange. A valuable tool in acute hepatic coma and Reye's syndrome. Am J Surg1977; 133: 522–30.
25.
SorrentinoF.. Prime ricerche per la realizzatione di un fegato artificiale. Chir Patol Sper1956; 4: 1401–14.
26.
HonM.. Artificial liver: The concept and working hypothesis of hybrid organs: from a 25-year old anecdote to the 21st century model. Trans Am Soc Artif Intern Org1982; 18: 639–41.
27.
KimotoS.. The artificial liver experiments and clinical application. ASAIO Trans1959; 5: 102–25.
28.
NoseY., MikamiJ., KasaiY.An experimental artificial liver utilizing extracorporeal metabolism with sliced or granulated canine liver. ASAIO Trans1963; 9: 358–62.
29.
MatsumuraK.. Method and device for purifying blood. US Patent No.3734851, US Patent Office, Washington 1973.
BerryM.N., FriendD.S.. High yield preparation of isolated rat liver parenchymal cells: a biochemical and fine structural study. J Cell Biol1969; 43: 506–20.
32.
MikamiJ., MotoM., NishimuraA.Surgical treatment of acute liver failure II: an experimental study of extracorporeal metabolism in the artificial liver using slices of canine liver. Jpn J Gastroenterol1959; 56: 1022–7.
33.
SoyerT., LempinenM., WalkerJ.E.Extracorporeal assist of anhepatic animals with liver slice perfusion. Am J Surg1973; 126: 20–4.
34.
KimuraK., GundermannK.J., LieT.S.. Hemoperfusion over small liver pieces for liver support. Int J Artif Organs1980; 4: 297–301.
35.
KawamuraA., TakahashiT., KumamotoK.The development of a new hybrid support system using frozen liver pieces (FLP). Jpn J Artif Organs1985; 14: 253–7.
36.
EisemanB., LiemD.S., RaffucciF.. Heterologous liver perfusion in treatment of hepatic failure. Ann Surg1965; 162: 329–45.
37.
AbounaG.M., CookJ.S., FisheL.M.Treatment of acute hepatic coma by ex vivo baboon and human liver perfusion. Surgery1972; 71: 537–47.
38.
LieT.S.. Extracorporeal hemoperfusion over the human and baboon liver. In: BrunnerG., MitoM., eds. Artificial liver support.Berlin-Heidelberg-New York: Springer-Verlag1992; 211–24.
39.
FoxI.J., LangnasA.N., OzakiC.F.Successful application of extracorporeal liver perfusion on the treatment of fulminant hepatic failure: a technology whose time has come. Am J Gastroenterol1993; 88: 1876–81.
40.
ChariR.S., CollinsB.H., MageeJ.C.Brief report: treatment of hepatic failure with ex vivo pig-liver perfusion followed by liver transplantation. N Engl J Med1994; 331: 234–7.
41.
BrunnerG., HollowayC.J., LosgenH.. The application of immobilized enzymes in an artificial liver support system. Artif Organs1979; 3: 27–30.
42.
EisemanB., NortonL., KraliosN.C.. Hepatocyte perfusion within a centrifuge. Surg Gynecol Obst1976; 142: 21–8.
43.
OlumideF., EliashivA., KraliosN.C.Hepatic support with hepatocyte suspensions in a permeable membrane dialyzer. Surgery1977; 82: 599–06.
MargulisM.S., ErukhimovE.A., AndreimanL.A.Temporary organ substitution by hemoperfusion through suspension of active donor hepatocytes in a total complex of intensive therapy in patients with acute hepatic insufficiency. Resuscitation1989; 18: 85–94.
46.
SussmanN.L., KellyJ.H.. Improved liver function following treatment with an extracorporeal liver assist device. ASAIO Trans1993; 17: 27–30.
47.
EllisA., HughesR., WendonJ.A.Pilot-controlled trial of the extracorporeal liver assist device in acute liver failure. Hepatology1996; 24: 1446–51.
48.
GerlachJ.C.. Development of a hybrid liver support system: a review. Int J Artif Organs1996; 19: 645–54.
49.
LiA.P., BarkerG., BeckD.. Culturing of primary hepatocytes as entrapped aggregates in a packed bed bioreactor: a potential bioartificial liver. In Vitro Cell Dev Biol1993; 29A: 249–54.
50.
ArnaoutW.S., MoscioniA.D., BarbourR.L.Development of bioartificial liver: Bilirubin conjugation in Gunn rats. J Surg Res1990; 48: 379–82.
51.
RozgaJ., WilliamsF., RoM-S. Development of a bioartificial liver: Properties and function of a hollow-fiber module inoculated with liver cells. Hepatology1993; 17: 258–65.
52.
RozgaJ., HolzmanM.D., RoM-S. Hybrid bioartificial liver support treatment of animals with severe ischemic liver failure. Ann Surg1993; 217: 502–11.
53.
RozgaJ., PodestaL., LePageE.Control of cerebral oedema by total hepatectomy and extracorporeal liver support in fulminant hepatic failure. Lancet1993; 342: 898–9.
54.
RozgaJ., Le PageE., MoscioniA.D.Clinical use of a bioartificial liver to treat fulminant hepatic failure. Ann Surg1994; 219: 538–46.
55.
DemetriouA.A., RozgaJ., PodestaL.Early clinical experience with a bioartificial liver. Scand J Gastroenterol1995; 305 Suppl 208: 111–7.
56.
ChenS., HewittW., EguchiS.Prolonged survival in anhepatic pigs treated with a bioartificial liver. Surgical Forum1996; XLVIII: 161–3.
57.
TreyC., DavidsonC.. The management of fulminant hepatic failure. Prog Liv Dis1970; 3: 282–98.
58.
O'GradyJ.G., AlexanderG.J., HayllarK.M., WilliamsR.. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology1989; 97: 439–45.
59.
StanczakD.E., WhiteJ.G., GouviewW.D.Assessment of level of consciousness following severe neurological insult. J Neurosurg1984; 60: 955–60.
60.
WatanabeF.D., MullonC.J.P., HewittW.R.Clinical experience with a bioartificial liver in the treatment of severe liver failure: a phase I clinical trial. Ann Surg1997; 225: 484–94.
