The elusive goal of liver support – quest for the Holy Grail

Williams, Roger

doi:10.7861/clinmedicine.6-5-482

Cited by 9 publications

(9 citation statements)

References 27 publications

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“…Early therapies involved simple haemodialysis and exchange blood transfusion, then developed to include blood perfusion through living pig liver or human cadaverous liver, plasmapheresis, haemoperfusion with active coal and finally to contemporary sophisticated biological or non-biological elimination devices [9,10] .…”

Section: Discussionmentioning

confidence: 99%

Fractionated Plasma Separation and Adsorption Significantly Decreases Intracranial Pressure in Acute Liver Failure: Experimental Study

Ryska¹,

Lasziková

Pantoflicek³

et al. 2009

Eur Surg Res

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Background: The aim of the study was to determine the influence of fractionated plasma separation and absorption (FPSA) on intracranial pressure (ICP) in acute liver failure (ALF). Methods: A surgical model of ALF in pigs (35–40 kg) was used. We compared laboratory data and haemodynamic parameters from the ALF control group to the ALF group treated by Prometheus using ANOVA with repeated measures and grouping factors, by calculating the area under the curve, and by the Mann-Whitney rank test. Results: Bilirubin levels differed significantly in favour of the FPSA treatment group: after 6 h 12.81 ± 6.54 versus 29.84 ± 9.99, after 9 h 11.94 ± 4.14 versus 29.95 ± 12.36 (p < 0.01) and after 12 h 13.88 ± 6.31 versus 26.10 ± 12.23 mmol/l (p < 0.05). ICP values differed significantly in favour of the FPSA treatment group: after 9 h 19.1 ± 4.09 versus 24.1 ± 2.85 (p < 0.01), after 10 h 21.9 ± 3.63 versus 25.1 ± 2.19, after 11 h 22.5 ± 3.98 versus 26.3 ± 3.50, and after 12 h 24.0 ± 4.66 versus 29.8 ± 5.88 mm Hg (p < 0.05). Conclusion: The authors demonstrated that a significant decrease in ICP was found in pigs with ALF following treatment by FPSA.

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Section: Discussionmentioning

confidence: 99%

Fractionated Plasma Separation and Adsorption Significantly Decreases Intracranial Pressure in Acute Liver Failure: Experimental Study

Ryska¹,

Lasziková

Pantoflicek³

et al. 2009

Eur Surg Res

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“…Also, perhaps with albumin dialysis we are at last getting nearer to developing an effective liver support device. 44,45 Public health organizations and government involvement can help to counteract pressures of lifestyle and to get currently available and effective drugs to those who need them most in deprived areas of the world. Government immunization programs are critical in limiting the spread of hepatitis B worldwide.…”

Section: Organ Donation and Liver Transplantationmentioning

confidence: 99%

Global challenges in liver disease

2006

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Immigration, cheap air travel, and globalization are all factors contributing to a worldwide spread of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. End-stage chronic liver disease (ESLD) as a result of co-infection with HBV/HCV is now the major cause of death for individuals who have been infected with the HIV virus. The high incidence of HCV infection in Egypt-the legacy left from the mass use of tartar emetic to eradicate schistosomiasis, as in other high prevalence areas-will take years to reduce. Steatohepatitis due to non-alcoholic fatty liver disease is developing into a new and major health problem as a result of rising levels of obesity in populations worldwide. Hepatic steatosis also has an adverse influence on the progression of other liver diseases including chronic HCV infection and alcoholic liver disease. In many countries, considerable public concern is on the rise due to increased levels of alcohol consumption adversely affecting younger and affluent age groups. With the rising prevalence of cirrhosis, primary hepatocellular carcinoma (HCC) is increasing in frequency as is that of primary intrahepatic cholangiocarcinoma. Finally, despite the successes of liver transplantation, many deserving patients are not getting transplants due to low levels of cadaver organ donation in many countries, thereby increasing pressures on the use of living donor liver transplantation. Only through a concerted effort from governments, health agencies, healthcare professionals at all levels, and the pharmaceutical industry can this grim outlook for liver disease worldwide be reversed. (HEPATOLOGY 2006;44:521-526.)

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“…These include phenols, bile acids, digoxin-like substances, benzodiazepines and mercaptans, many of which are protein or lipid bound and led to trials of exchange transfusion and later of extracorporeal perfusion of isolated animals livers. 5 Encouraging improvements in encephalopathy were observed but overall survival was unaffected. A major breakthrough came in the early 1970s with the development of haemoperfusion columns containing the powerful adsorbent -activated charcoal.…”

Section: Liver Support Devicesmentioning

confidence: 98%

“…4 The organ donation rate in Spain of 33.8 compared with 12.9 per million population in the UK, with corresponding liver transplant rates of 23. 5 …”

Section: Liver Transplantationmentioning

confidence: 99%

“…4 When lymphocytes are activated by dendritic cells (DC) in gut-associated lymphoid tissues (GALT) they are not only programmed to respond to antigen but are also imprinted with a homing phenotype which directs their subsequent trafficking back to the gut. 5 After antigen has been cleared, a population of long-lived memory cells remain that retain gut tropism and thereby provide immune surveillance against the same pathogen entering the gut in the future. The molecular basis of this tissuespecific homing has recently been elucidated.…”

Section: Liver Support Devicesmentioning

confidence: 99%

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