Prospects for Extracorporeal Liver Support

Jalan, Rajiv; Sen, Sambit; Williams, Roger

doi:10.1136/gut.2003.024919

Cited by 81 publications

(75 citation statements)

References 59 publications

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“…artificial), similar to hemodialysis used in renal insufficiency, while others contain active liver cells in the circuit (i.e. bioartificial) [34]. The possible efficacy of these procedures in HE has been investigated either in acute liver failure or cirrhosis.…”

Section: The Pathophysiological Basis Of He Therapymentioning

confidence: 99%

Hepatic Encephalopathy: From Pathophysiology to Treatment

Mas¹

2006

Digestion

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Hepatic encephalopathy (HE) is a neuropsychiatric syndrome due to hepatic dysfunction and porto-systemic shunting of the intestinal blood. Cirrhosis is the most frequent liver disease causing HE. On most occasions, HE appears due to a superimposed precipitating factor (gastrointestinal bleeding, infections, renal and electrolyte disturbances, etc.). Ammonia produced in colon by intestinal bacteria is the main toxic substance implicated in the pathogenesis of HE. Other mechanisms, such as changes in the GABA-benzodiazepine system, accumulation of manganese into the basal ganglia of the brain, changes in blood-brain barrier and neurotransmission disturbances are also present. Clinical manifestations of HE may vary widely, from minimal neurologic changes, only detected with specific tests, to deep coma. Treatment of HE should be directed to controlling the precipitating factors, as well as therapies aimed at correcting the above-mentioned pathophysiological changes, mainly reduction of blood ammonia levels. Artificial liver support systems may play a role in the future. Liver transplantation should be evaluated as a definitive therapy in all cases of HE.

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Section: The Pathophysiological Basis Of He Therapymentioning

confidence: 99%

Hepatic Encephalopathy: From Pathophysiology to Treatment

Mas¹

2006

Digestion

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“…At present, the treatment of acute and acute-on-chronic liver failure is carried out with extra-corporeal devices aimed at bringing patients out of the acute phase safely or bridging them to an organ transplantation [1][2][3]. Clinical options fall into two classes: purely artificial and bioartificial devices.…”

Section: Introductionmentioning

confidence: 99%

Bilirubin and tryptophan adsorption in albumin-containing solutions

Annesini

Carlo

Piemonte

et al. 2008

Biochemical Engineering Journal

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“…Additionally, the global burden of liver disease is increasing steadily due to the increasing prevalence of hepatitis C and non-alcoholic fatty liver disease. [11][12][13][14] Currently in the US, liver diseases are the 10th most common cause of death and responsible for an associated economic burden of approximately 1% of the total national healthcare expenditure ($1.2 trillion in 1999). 15 These observations clearly underline the potential usefulness of a device for extracorporeal liver support therapy if it can facilitate an improved environment for hepatic regeneration and clinical recovery.…”

Section: Is There a Need For Liver Support/ Replacement Therapies?mentioning

confidence: 99%

Review article: non‐biological liver support in liver failure

Laleman¹,

Wilmer²,

Evenepoel³

et al. 2006

Aliment Pharmacol Ther

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SUMMARYLiver failure, whether acute or acute-on-chronic, remains an important cause of morbidity and mortality. The lack of liver detoxification, metabolic and regulatory functions of the liver leads to life-threatening complications, such as renal failure, altered immune response, hepatic coma and systemic haemodynamic dysfunction, eventually culminating in multiorgan failure.Current medical therapy involves the management of the precipitating event and treatment of complications until the liver eventually recovers, leaving us with no other treatment options than transplantation if these attempts fail. However, the shortage in cadaveric organs and other transplant-related problems, have prompted the need for alternative methods to provide liver support.As liver failure is often potentially reversible, considerable effort has been invested in the development of liver support systems. Currently, most of the experience is available for non-biological support systems. They represent the focus of this review, which aims to define the goals of liver support, to describe the design of the different existing devices and to analyse the available data to determine their current status in the management of patients with liver failure.

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Prospects for Extracorporeal Liver Support

Cited by 81 publications

References 59 publications

Hepatic Encephalopathy: From Pathophysiology to Treatment

Hepatic Encephalopathy: From Pathophysiology to Treatment

Bilirubin and tryptophan adsorption in albumin-containing solutions

Review article: non‐biological liver support in liver failure

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