Extracorporeal liver support devices for listed patients

Abstract

An alternative to liver transplantation for patients with liver failure remains an unmet need. In acute liver failure, the ideal extracorporeal liver support device (ELSD) would replace the functions of the failing liver in order to permit spontaneous recovery, given the incredible regenerative potential of the liver, negating the need for transplantation. In acute‐on‐chronic liver failure, an ELSD would ideally support hepatic function until a recovery to liver function before acute decompensation or until liver transplantation. In decompensated cirrhosis, an ELSD could again be used to support hepatic function until transplant. In addition, ELSDs may have the potential to treat the multiorgan failure that accompanies liver failure including hepatic encephalopathy, renal failure, and immune dysfunction or indeed potential to promote liver regeneration. Creation of an extracorporeal bioartificial liver able to completely replace liver function remains an unmet need. This review will describe a number of technologies suitable for clinical trials in humans, which have resulted from decades of engineering and biological research to develop a bioreactor able to adequately sustain functional hepatocytes. In addition, this review will describe artificial liver support devices that are primarily designed to replace the detoxifying functions of the liver and will consider the current data available or studies required to support their use in liver failure patients on the transplant waiting list. Liver Transplantation 22 839–848 2016 AASLD.

Alleviating liver failure conditions using an integrated hybrid cryogel based cellular bioreactor as a bioartificial liver support

“…Extracorporeal liver devices are considered the next best alternative to liver transplantation by aiding in the recovery of patients to normal health in the case of acute liver failure (ALF) or returning them to a state before decompensation in the case of acute-on-chronic liver failure (ACLF)12. These extracorporeal support systems, aimed at improving the transplant-free survival of patients, may also serve as a bridge to transplantation and/or prevent progress to further severe damage to the liver and other vital organs that could result in end-organ dysfunction13456.…”

“…These extracorporeal support systems, aimed at improving the transplant-free survival of patients, may also serve as a bridge to transplantation and/or prevent progress to further severe damage to the liver and other vital organs that could result in end-organ dysfunction13456.…”

Acute liver failure: An up-to-date approach

“…A meta-analysis has shown that these systems failed to improve survival in ALF [66]. Nevertheless, more well-designed clinical trials in humans are likely needed to fully evaluate these systems efficacy and safety [67].…”

Fabrication of nanocomposites and hybrid materials using microbial biotemplates

“…3 Bacteria-based microswimmers addition, these bacteria-based microswimmers have higher average velocities, and thus, microbeads can be used as drug carriers in drug delivery systems [62]. 4 Artificial microbes: design an efficient microbe to achieve a specific desired output…”

“…Although the success rate is very low and technology is limited by several factors, the development of recent fabrication strategies has made it more realistic. Living animal cells are important raw materials for biofabrication of animal-free meat [3], extracorporeal devices [4], and human tissues and organs [5,6]. However, their usage has been overshadowed by limited availability, handling, controlled process development, and limited in vitro survival rate during extended incubation.…”