Clinical Experience of Postoperative Hepatic Failure Treatment with Pig or Baboon Liver Cross‐Hemodialysis with an Interposed Membrane

Abstract

The present study emphasizes the principle of using liver support to restore the blood ketone body ratio (acetoacetate/beta-hydroxybutyrate), which reflects the redox potential of liver mitochondria and correlates with hepatic energy charge (ATP + 0.5ADP/ATP + ADP + AMP). Eleven surgical patients with grade IV hepatic coma were treated by an ex vivo pig or baboon liver cross-hemodialysis with an interposed Cuprophan membrane when their blood ketone body ratios had decreased to below 0.4 compared with the normal of above 0.7. Three patients were treated by cross-hemodialysis using a standard Cuprophan membrane dialyzer without increase of blood ketone body ratio and without marked beneficial effect. However, five of eight patients who had blood ketone body ratios of above 0.25 became fully alert after treatment by cross-hemodialysis using the larger pore size and greater surface area Cuprophan membrane, concurrent with a rise in the decreased blood ketone body ratio, and three of them were later discharged. By contrast, in the three patients with blood ketone body ratios below 0.25, there was no restoration of consciousness and no improvement in their blood ketone body ratios by this liver support. It is suggested that, as long as the blood ketone body ratio remained over 0.25, this metabolic liver support is effective in restoring grade IV hepatic coma.

Aspects of our liver support systems using extracorporeal xenoperfusion of pig or baboon liver: review

“…The other patients again showed severe liver failure after the treatment and died following multiple organ failure. Detailed results of the first 11 patients were reported elsewhere 17…”

Energy Metabolism of Porcine Liver during a 72-Hour Hypothermic Perfusion with UW Solution

“…The per fusate was maintained at pH 7.35-7.45 by adding sodium hydroxide. During perfusion, insulin (4 IU/h) and heparin (500 IU/h) were continuously injected into the perfusate [10,11]. In the simple cold storage (SCS) group, after the flushout mentioned above, 800 ml of UW solution was infused into the liver.…”

“…The liver was then excised and stored in UW solution for 72 h at 4 °C. In order to compare the viability of the preserved livers between the two groups, the livers were recirculated for 2 h at 37 "C with 1,400 ml of human blood mixed with 500 ml of human fresh fro zen plasma, 50 g of low-molecular-weight dextran (40,000 daltons), and 5,000 IU of heparin [10,11], The blood was oxygenated as described above and maintained at pH of 7.35-7.45 by adding sodium bicarbonate.…”

Extrakorporale Leberunterstützungsverfahren in der Therapie des akuten Leberversagens Eine Standortbestimmung

“…Neben dem totalen Blutaustausch, der Mensch-zu-Mensch-oder Tier-zuMensch-Kreuzzirkulation sowie der extrakorporalen Leberperfusion wurden auch die verschiedenen entgiftenden Filtrationsverfahren wie Hämofiltration, Hämodialyse, Hämoperfusion oder Plasmapherese erprobt (Tabelle 1) [1, 7,9,11,16,18,26].…”