Current Benefit of Biological and Non-biological Methods in the Treatment of Acute Liver Failure


Authors: O. Ryska 1;  T. Pantoflíček 2;  E. Lásziková 3;  J. Pražák 4;  M. Ryska 2
Authors‘ workplace: Chirurgická klinika 1. LF UK a IPVZ, FN Bulovka, Praha, přednosta: prof. MUDr. F. Antoš, CSc. 1;  Chirurgická klinika 2. LF UK a ÚVN Praha, přednosta: prof. MUDr. M. Ryska, CSc. 2;  Oddělení anesteziologie a resuscitace ÚVN Praha, primář: MUDr. B. Jurenka 3;  Klinika anesteziologie, resuscitace a intenzivní péče 2. LF UK, přednosta: prof. MUDr. K. Cvachovec, CSc. Centrum buněčné terapie a tkáňových náhrad, 2. LF UK, hlavní řešitel: prof. MUDr. E. Syková, DrSc. 4
Published in: Rozhl. Chir., 2008, roč. 87, č. 6, s. 291-296.
Category: Monothematic special - Original

Overview

Background:
There was an active interest in development of liver assist device in the last two decades. Using these devices to bridge patients with acute hepatic failure (AHF) to ortotopic liver transplantation (OLTx) or to liver regeneration might decrease the mortality rate. Several liver support systems have been described in different stages of experimental or clinical examination.

Methods:
PubMed (1986–2008) was searched using the keywords „artifitial livers“, „liver support“, „bioartifitial liver“ and „cell transplantation“. The own experience presenting by authors are the conclusions of their publications.

Results and discussion:
Biological liver support (BAL) uses hepatocytes can support theoretically both detoxification and biosynthesis. Experimental study confirmed significant decrease in some of AHF metabolites. Nevertheless, randomized study didn’t show any improvement in patient’s survival. Source of viable hepatocytes and sufficient bioreactor capacity are some of unsolved problems. Nonbiological liver support as a plasma exchange, hemodialysis, hemofiltration, albumin dialysis or adsorbent recycling systems eliminate some of toxins, but other specific liver functions can’t replace. MARS® and Prometheus® devices have been used successfully in treatment of AHF by human. However, the absence of randomized study still lasts. These devices remove some of toxins and cytokines unselectively and are also limited by adsorber capacity. Selective plasma filtration therapy and hybrid liver support systems which combine both of management advances present the possible solution. Authors themselves confirmed by application of both methods a significant decrease of bilirubin level. Intracranial pressure declines only by use of non-biological device – Prometheus®.

Conclusion:
Effective liver assist device that gains a survival approval hasn’t been developed till now. In confrontation with other current used cure possibilities, BAL didn’t propose the original expectations. On the other hand, the non-biological devices seem to be perspective and their contribution has been proved by prospective studies. The randomized study is still absent. Authors’ experiences confirm this trend.

Key words:
acute hepatic failure – artifitial liver – non-biological liver support – liver support


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