Liver failure, whether arising directly from acute liver failure or from decompensated chronic liver disease is an increasing problem worldwide and results in many deaths. In the UK only 10% of individuals requiring a liver transplant receive one. Thus the need for alternative treatments is paramount. A BioArtificial Liver machine could temporarily replace the functions of the liver, buying time for the patient’s liver to repair and regenerate. We have designed, implemented and tested a clinical-scale BioArtificial Liver machine containing a biomass derived from a hepatoblastoma cell-line cultured as three dimensional organoids, using a fluidised bed bioreactor, together with single-use bioprocessing equipment, with complete control of nutrient provision with feedback BioXpert recipe processes, and yielding good phenotypic liver functions. The methodology has been designed to meet specifications for GMP production, required for manufacture of advanced therapy medicinal products (ATMPs). In a porcine model of severe liver failure, damage was assured in all animals by surgical ischaemia in pigs with human sized livers (1.2–1.6 kg liver weights). The BioArtificial liver (UCLBAL) improved important prognostic clinical liver-related parameters, eg, a significant improvement in coagulation, reduction in vasopressor requirements, improvement in blood pH and in parameters of intracranial pressure (ICP) and oxygenation.

Background: HIV infection is associated with haematological changes, including thrombocytopaenia. Pregnancy induces a hypercoagulable state. There are limited data on the coagulation status of women with term pregnancy and HIV receiving antiretroviral medication. Regional anaesthesia is the technique of choice for caesarean section (CS), and is contraindicated in a hypocoagulable state. We therefore investigated the coagulation status of term pregnant women with HIV, presenting for elective CS. Methods: This was a single-centre cross-sectional observational study, using thromboelastography, comparing the coagulation status of HIV-negative and -positive women with no other comorbidities, in pregnancy at term. A blood sample was taken immediately prior to spinal anaesthesia, and thromboelastography was performed within four minutes. In addition, platelet count, haemoglobin, and fibrinogen level were measured. Results: Blood samples were obtained from 75 patients. There were no between-group differences in obstetric and demographic data, and no difference in platelet count. The mean (standard deviation [SD]) fibrinogen level was higher in HIV positive women (3.9 [1.5] vs 3.5 [0.7] g/L) respectively, p = 0.04. There were no significant differences in the r time, alpha angle, k time, maximum amplitude (MA), or LY-30. Conclusions: The results of this thromboelastography study show that in asymptomatic HIV-positive pregnant patients on antiretroviral treatment, there are no significant differences in coagulation parameters when compared with HIV-negative patients. This suggests that routine assessment of coagulation is unnecessary before spinal anaesthesia in patients without further comorbidities. Further studies could demonstrate the incidence of abnormalities in coagulation or platelet function in patients with AIDS-defining disease or HIV-positive patients with other comorbidities.