Chapter category: Tissue Engineering
Clinical Experience with a Bioartificial Liver
Support of the Acutely Failing Liver
Second Edition
Edited by: Achilles A. DemetriouISBN: 1-57059-585-2
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Chapter authors:
Frederick D. Watanabe, Elaine Kahaku, Theodore Khalili, Paul Ting, Anthony, Anthony Navarro, Achilles A. Demetriou
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In spite of substantial advances in general supportive therapy and critical care, mortality in fulminant hepatic failure (FHF) remains unacceptably high, due primarily to incomplete understanding of the pathophysiology of the disease.1 Despite this, clinicians have attempted to develop rational novel therapeutic modalities focusing mostly on plasma detoxification.2–7 Whole liver perfusion using either human or xenogeneic organs has been used successfully to treat patients with FHF, but is limited by lack of human livers and logistical considerations in the case of animal organ use.8-9
In previous sections of this monograph we presented the rationale for using intact isolated cryopreserved hepatocytes to develop a bioartificial liver (BAL). Several investigators have developed and tested a variety of hepatocyte-based systems.10-15 We have developed a BAL containing porcine hepatocytes and have demonstrated its ability to provide detoxifying and synthetic functions in a series of in vitro and in vivo animal experiments as well as pilot clinical studies.2,16-20 The system has been described in detail in earlier sections of this monograph as well as in a more recent publication.21 Based on the data collected from these studies, BAL design was optimized, and we arrived at the system used in the clinical trial described here. The purpose of this section is to provide an update of the clinical experience with our BAL.
Additional chapters from this book:
Other Experimental Therapeutic Strategies: Hepatocyte Transplantation
Helene Lilja, Nikolaos Arkadopoulos, Susumu Eguchi
Transplantation of hepatocytes, injection of various hepatocyte extracts and hepatocyte culture supernatants, have been shown to prolong survival in animals with D,(+)–galactosamine...
Other Experimental Therapeutic Strategies: Liver Gene Therapy
Jacek Rozga, Helen Lilja, Walid Arnaout, Achilles A. Demetriou
Somatic human gene therapy has been a topic of surging interest during the last several years. Initial results of experiments altering transformed cell lines to produce foreign gene product...
Development of a Strategy for Management of Severe Acute Liver Failure: The Liver Support Unit
Achilles A. Demetriou, Frederick D. Watanabe
As we have repeatedly emphasized throughout this monograph, severe acute liver failure (SALF) is associated with very high morbidity and mortality and represents one of the most challenging pr...
Clinical Use of a Bioartificial Liver to Treat Acetaminophen-Induced Fulminant Hepatic Failure
Olivier Detry, Nikolaos Arkadopoulos, Elaine Kahaku, Frederick D. Watanabe, Jacek Rozga, Achilles A. Demetriou
Acetaminophen toxicity may cause massive hepatocellular necrosis leading to fulminant hepatic failure (FHF).1,2 In acetaminophen-induced FHF patients, prognosis can be accurately...
Clinical Experience with a Bioartificial Liver
Frederick D. Watanabe, Elaine Kahaku, Theodore Khalili, Paul Ting, Anthony, Anthony Navarro, Achilles A. Demetriou
In spite of substantial advances in general supportive therapy and critical care, mortality in fulminant hepatic failure (FHF) remains unacceptably high, due primarily to incomplete underst...
Liver Support System Development
Jacek Rozga, Kyung.S. Suh, Helene Lilja, Walid S. Arnaout, Achilles A. Demetriou
For many years it has been assumed that the majority of toxins which cause coma in hepatic failure are small dialyzable molecules. As a result, most liver support systems and therapeutic regim...
Surgical Management of Acute Liver Failure
Walid S. Arnaout, David Reybould
Fulminant hepatic failure (FHF) continues to be one of the most devastating conditions affecting thousands of individuals each year. By definition, these are patients who were previously he...
Medical Management of Acute Liver Failure
Frederick D. Watanabe, Elaine Kahaku, Achilles A. Demetriou
Despite advances in critical care management, prognosis in fulminant liver failure (FHF) remains poor, with mortality between 70 and 90%.1 Introduction of orthotopic liver transplan...
Acute Hepatic Encephalopathy: Treatment
Olivier Detry, Jody E. Margulies, Nicholas Arkadopoulos, Achilles A. Demetriou
Intracranial hypertension secondary to brain edema is the most common cause of death in fulminant hepatic failure (FHF) patients, even when they are listed for urgent orthotopic liver transpla...
Acute Hepatic Encephalopathy: Pathophysiology and Diagnosis
Steven D. Colquhoun, Caroline A. Connelly
Hepatic encephalopathy is a neuropsychiatric syndrome that refers to potentially reversible derangement of thought and behavior which accompany liver disease.1 Although there may be...
Acute Liver Failure: Definitions and Etiology
Donna E. Goldman, Graham M. Woolf
In the United States, there are approximately 2000 cases/year of acute hepatic failure (AHF) in adults and children.1 The term "fulminant hepatitis" was introduced by Lucke and Mall...
The Liver: A Brief Historical Perspective
Elaine Kahaku
The United Nations has recommended standardized dating using BCE, for 'before the common era', instead of BC and CE, for 'common era', instead of AD.
Throughout history, man has strive...
