Artificial and bioartificial liver devices: present and future

Abstract

Liver failure is associated with high morbidity and mortality without transplantation. There are two types of device for temporary support: artificial and bioartificial livers. Artificial livers essentially use non-living components to remove the toxins accumulated during liver failure. Bioartificial livers have bioreactors containing hepatocytes to provide both biotransformation and synthetic liver functions. We review here the operating principles, chemical effects, clinical effects and complications of both types, with specific attention paid to bioartificial systems. Several artificial support systems have FDA marketing authorisation or are CE labelled, but the improvement they provide in terms of patient clinical outcome has not yet been fully demonstrated. At present, different bioartifical systems are being investigated clinically on the basis of their promises and capacity to provide and replace most liver functions. However, important issues such as cost, cell availability, maintenance of cell viability and functionality throughout treatment, and regulatory issues, as well as difficult challenges, including implementing cell-housing devices at the patient's bedside on an emergency basis, have delayed their appearance in intensive care units and on the market. Bioreactors are, nevertheless, when combined with artificial components, a pragmatic approach for future treatment of liver failure.

Liver Regeneration and Bioengineering - The Emergence of Whole Organ Scaffolds

“…Recent advances in the design of these devices allow now utilizing them in the recovery of the native liver from an acute injury. Thus, these devices can either bridge the patients to liver transplantation or can fully avoid the need for it (10). Liver support devices can be broadly classified into two classes: artificial liver (AL) devices and bioartificial (BAL) devices.…”

“…Liver support devices can be broadly classified into two classes: artificial liver (AL) devices and bioartificial (BAL) devices. The artificial support devices are designed to detoxify the blood or plasma via different methods like hemodialysis, hemofiltration, hemodiafiltration, hemadsorption, plasmapheresis, plasma fractionation and albumin dialysis (10,11). Bioartificial support devices are targeted towards providing essential metabolic and synthetic functions of liver along with removal of toxins.…”

“…This result in removal of toxins from the blood as the toxins are adsorbed based on their binding affinities (10,13). The MARS uses an albumin-impermeable membrane (50 kDa cutoff) which separates the high-flux albumin coated dialyser from albumin filled dialysate.…”

Organic-polymeric radial flow biorreactor for liver models

“…Liver transplantation is currently the only medical aid for patients with fulminant and/or chronic liver disease (Carpentier, 2009). Nevertheless, the waiting list for hepatic transplantation is usually long, so it is imminent to improve the actual technology to build artificial liver support systems, known as bioartificial liver (BAL) (Carpentier, 2009;McKenzie, 2008).…”

“…Nevertheless, the waiting list for hepatic transplantation is usually long, so it is imminent to improve the actual technology to build artificial liver support systems, known as bioartificial liver (BAL) (Carpentier, 2009;McKenzie, 2008).…”