Last update:
12-Dec-2000

Arch Hellen Med, 17(3), May-June 2000, 285-292

REVIEW

Intensive care and fulminant hepatic failure.
Contemporary methods of liver function support

G. GEROLOUKA-KOSTOPANAGIOTOU,¹ V. SMYRNIOTIS^2
1Anesthesiology Unit,
²2nd Department of Surgery, University of Athens, Medical School, Aretaieion Hospital, Athens, Greece

Fulminant hepatic failure (FHF) is a disease with significant morbidity and mortality. Their management in intensive care units and the possibility of liver transplantation have provided the means to rescue patients with FHF from near-certain death. Severe organ donor shortage results in a high death rate among patients on the orthotopic liver transplantation waiting list but development of effective artificial liver support and methods devices may prolong opportunity to provide a donor liver (“bridge to transplant”), or to allow the native liver to regenerate. The history of these methods is lengthy and includes plasmapheresis, charcoal hemoperfusion and extracorporeal perfusion utilizing slices of liver. In orthotopic auxiliary liver transplantation a portion of the native liver is removed and replaced by a reduced-size graft. Advantages of this method are maintenance of native liver in anticipation of possible recovery and avoidance of the need for lifelong immunosuppression. Bioartificial liver holds the most promise for extracorporeal liver support but it presents a unique technological challenge. It artificially reproduces an array of complex liver functions and corrects metabolic, hemodynamic, and neurological disturbances, such as hepatic encephalopathy. Hepatocyte transplantation avoid the use of a whole liver and major surgery, and allows the use of one or more living, related donors and multiple courses of treatment. It might provide temporary hepatic support without committing the patient to lifelong immunosuppression and has been applied in several animal models of liver disease. Extracorporeal whole-liver perfusion has been used to provide support in patients with acute liver failure as a bridge to transplantation. Further modifications of this technique may utilize transgenic liver perfusion to minimize immunologic reactions to the liver graft. Transplantation of whole liver xenografts as a bridge to standard transplantation, despite initial functioning of the liver, is accompanied with severe immunologic reactions. Transgenic technology and immunomodulation will offer increased treatment support possibilities to patients with end-stage liver disease.

Key words: Fulminant hepatic failure, Hemoperfusion, Hepatocytes, Liver, Transplantation.