Chapter category: Tissue Engineering
Clinical Use of a Bioartificial Liver to Treat Acetaminophen-Induced Fulminant Hepatic Failure
Support of the Acutely Failing Liver
Second Edition
Edited by: Achilles A. DemetriouISBN: 1-57059-585-2
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Chapter authors:
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 assessed using criteria defined by the King's College Hospital (KCH) group.3 According to these widely accepted and validated criteria, in the absence of orthotopic liver transplantation (OLT) the probability of patient death is 90% if:
- The arterial blood pH is less than 7.3 at 24 hours or later after acetaminophen
ingestion, assuming appropriate volume loading; or - A serum creatinine level greater than 300 µmol/l, hepatic encephalopathy grade of III-IV and an international normalized ratio (INR) greater than 7 are concurrently present.4-7
OLT remains the only definitive treatment for FHF patients who fulfill the above criteria. However, access to OLT is limited by organ donor shortage, psychiatric and other contraindications as well as high cost and significant associated morbidity.5,8 In our institution, we have developed a treatment strategy based on the use of an extracorporeal bioartificial liver (BAL) support system.9 In this section, we describe the successful clinical application of BAL support to treat patients with acetaminophen-induced FHF.
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...
