Extracorporeal liver support

Stange, Jan

doi:10.4161/org.7.1.14069

Cited by 31 publications

(27 citation statements)

References 49 publications

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“…6,7 However, these techniques have limited application because of their respective disadvantages. For example, hemodialysis and hemofiltration are effective only for water-soluble toxins 6,8 ; hemoperfusion and plasma perfusion may cause a loss of valuable substances from patients; hemoperfusion, plasma perfusion, and plasma exchange can result in serious immune problems in patients. 9 In the 1990s, the development of albumin dialysis technology provided a new hope in the treatment of liver failure.…”

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confidence: 99%

“…3 A loss of the detoxifying function of the liver causes the accumulation of toxins, and especially proteinbound toxins, in the human body and, consequently, multiple organ failure. [4][5][6] Various approaches have been proposed to remove these toxins to bridge patients to liver transplantation, such as hemodialysis, hemofiltration, hemoperfusion, plasma perfusion, and plasma exchange. 6,7 However, these techniques have limited application because of their respective disadvantages.…”

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confidence: 99%

“…[4][5][6] Various approaches have been proposed to remove these toxins to bridge patients to liver transplantation, such as hemodialysis, hemofiltration, hemoperfusion, plasma perfusion, and plasma exchange. 6,7 However, these techniques have limited application because of their respective disadvantages. For example, hemodialysis and hemofiltration are effective only for water-soluble toxins 6,8 ; hemoperfusion and plasma perfusion may cause a loss of valuable substances from patients; hemoperfusion, plasma perfusion, and plasma exchange can result in serious immune problems in patients.…”

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confidence: 99%

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Albumin Dialysis in Artificial Liver Support Systems

Pei¹,

Sun

et al. 2015

ASAIO Journal

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In artificial liver support systems, the open-loop albumin dialysis mode (OLM) is usually used to remove protein-bound toxins from the blood of patients with liver failure. However, there is still interest in the closed-loop albumin dialysis mode (CLM) because this mode may enable not only the regeneration and reuse of albumin but also the miniaturization of artificial liver systems. In this article, we compared the two modes under a fixed amount of albumin in dialysate experimentally and theoretically. The results show that according to the detoxification efficiency in the 3 hour dialysis for removing albumin-bound bilirubin, CLM is better than OLM. The usage efficiency of albumin in CLM is also higher. Moreover, the advantage of CLM is more significant when the concentration of bilirubin in blood is lower. Under a given amount of albumin in dialysate, if the concentration of bilirubin in blood is high, one may further increase the performance of CLM by means of increasing the flow rate of the albumin dialysate or using the highly concentrated albumin dialysate.

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Albumin Dialysis in Artificial Liver Support Systems

Pei¹,

Sun

et al. 2015

ASAIO Journal

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“…Due to limited treatment and transplant options, survival remains around 50% [1,2,6]. Therapeutic modalities such as extracorporeal liver support (ELS) using albumin augmented clear- ance deserve consideration and assessment for safety and efficacy, as they may provide a bridge to transplant or recovery [4,5,7]. Clinically significant bleeding is seen in less than 5% of LF patients due to synthetic loss of both pro and anticoagulation factors [2].…”

Section: Introductionmentioning

confidence: 99%

“…Our usual practice at Texas Children's Hospital is RCA for all acute renal extracorporeal therapies including the CRRT and MARS circuits. ELS is utilized in children with acute and chronic LF as well as toxic ingestions to serve as a potential bridge to recovery or transplant [1,4,6,7]. RCA has been shown to be superior to anticoagulation-free ELS in regards to patient safety and circuit efficacy in the adult population [21,22].…”

Section: Introductionmentioning

confidence: 99%

The Safety and Efficacy of Regional Citrate Anticoagulation in Albumin-Assisted Liver Dialysis for Extracorporeal Liver Support in Pediatric Patients

Lion¹,

Pekkucuksen²,

Srivaths³

et al. 2018

Blood Purif

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Aims: To establish the safety and efficacy of regional citrate anticoagulation (RCA) for pediatric liver failure (LF) patients receiving extracorporeal liver support (ELS) with albumin-assisted dialysis. Methods: Retrospective review of pediatric LF patients receiving ELS from April 2014 to December 2016 at a tertiary children’s hospital pediatric intensive care unit. Demographic and ELS data collected by chart review. Citrate accumulation (CA) was defined as total calcium (mmol/L): ionized calcium (mmol/L) > 2.5 (tCa:iCa). Efficacy was assessed by treatment duration. Safety was assessed by adverse events: bleeding, hemodynamic instability, arrhythmias, unplanned treatment discontinuation. Results: Fifteen patients (median age 3 [interquartile range (IQR) 0.7–8.0]) received 108 ELS treatments (median 5 [IQR 4–7.5]). Sixty-eight episodes of CA were identified. Of those, 6 coincided with intervention and 1 coincided with ELS discontinuation. There were no deaths attributed to ELS or RCA. Conclusion: RCA provides safe and effective anticoagulation for pediatric LF patients requiring ELS.

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Biomaterials and Culture Technologies for Regenerative Therapy of Liver Tissue

Pérez

Jung

Kim

2016

Adv Healthcare Materials

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Regenerative approach has emerged to substitute the current extracorporeal technologies for the treatment of diseased and damaged liver tissue. This is based on the use of biomaterials that modulate the responses of hepatic cells through the unique matrix properties tuned to recapitulate regenerative functions. Cells in liver preserve their phenotype or differentiate through the interactions with extracellular matrix molecules. Therefore, the intrinsic properties of the engineered biomaterials, such as stiffness and surface topography, need to be tailored to induce appropriate cellular functions. The matrix physical stimuli can be combined with biochemical cues, such as immobilized functional groups or the delivered actions of signaling molecules. Furthermore, the external modulation of cells, through cocultures with nonparenchymal cells (e.g., endothelial cells) that can signal bioactive molecules, is another promising avenue to regenerate liver tissue. This review disseminates the recent approaches of regenerating liver tissue, with a focus on the development of biomaterials and the related culture technologies.

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Extracorporeal liver support

Cited by 31 publications

References 49 publications

Albumin Dialysis in Artificial Liver Support Systems

Albumin Dialysis in Artificial Liver Support Systems

The Safety and Efficacy of Regional Citrate Anticoagulation in Albumin-Assisted Liver Dialysis for Extracorporeal Liver Support in Pediatric Patients

Biomaterials and Culture Technologies for Regenerative Therapy of Liver Tissue

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