Review of Support Systems Used in the Management of Fulminant Hepatic Failure

Abstract

Fulminant hepatic failure has an exceedingly high mortality. Liver transplantation is the treatment option of choice. Unfortunately, one-third of patients with fulminant hepatic failure die awaiting a donor liver. For over 35 years attempts to remove or dilute putative toxins in the blood have been unsuccessful in improving survival rates. The use of biocompatible interfaces with blood or plasma and current hepatocyte culture techniques have led to the development of new support systems. This generation of bioartificial livers will hopefully provide the necessary hepatic functions and prevent many of the complications associated with fulminant hepatic failure. This paper will review the support systems tried and currently under investigation, with an emphasis on bioartificial livers.

Oxygen Consumption Characteristics of Porcine Hepatocytes

“…Otherwise, the oxygen consumption could lead to local domains where a significant fraction of cells are either hypometabolic or dead from low oxygen tension (Foy et al, 1994;Gerlach et al, 1990;Hu et al, 1997;Jauregui et al, 1996;McGuire et al, 1995;Nyberg et al, 1992a, 1994Stefanovich et al, 1996;Yarmush et al, 1992). This is particularly true of newer high-density cell packing topologies or multicellular systems (Bader et al, 1995;Dixit, 1994;Gerlach, 1996;Gerlach et al, 1994;Hu et al, 1997;Hughes and Williams, 1996).…”

Advances in bioartificial liver devices

“…Hemoperfusion, in use since the 1960s, removes toxins but also some useful metabolites (growth factors, clotting factors, etc.) from blood 93 or plasma 94 circulating through a charcoal column; the column may also activate leukocytes, causing cytokine release. One bioartificial device, the HepatAssist system, which is currently in clinical trials, places a charcoal column before the hollow fiber cell cartridge.…”

Critical Care Apheresis: Hepatic Failure

“…The critical cell mass appears to be 20% of the volume of the original organ. Nevertheless, success has been reported frequently, and these systems show great promise as a temporary solution to the problem of hepatic failure ( 13).…”