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Technology Insight: liver support systems

Nature Clinical Practice Gastroenterology & Hepatology volume 2, pages 398–405 (2005)Cite this article

Abstract

Emergency orthotopic liver transplantation (OLT) is currently the only standard treatment for fulminant hepatic failure (FHF). The waiting time for transplantation can exceed a week—using a liver assist device to bridge patients with FHF to OLT might therefore decrease the mortality rate. Several liver support systems have been described, but no system has gained FDA approval or widespread clinical acceptance. Although the results of many experimental and clinical trials are encouraging, the field is still in its initial stages. Using nonbiologic liver support is based on the assumption that several toxins that cause hepatic coma can be removed from the circulation by blood or plasma sorption methods. As these toxins could be involved in many FHF complications recovery without the need for transplantation is the ultimate aim. Biologic liver support uses xenogeneic livers or hepatocytes to support the failed human liver, exploiting biological cell functions, namely detoxification, metabolism, and biosynthesis. The classical nonbiologic dialysis methods could decrease mortality in patients with acute-on-chronic liver failure, but definitive conclusions are impossible to draw because of the small number of patients studied and inadequate follow-up. Larger studies performed in specialty centers should provide conclusive data about the role of the bioartificial liver support system as a possible universal bridge to OLT. This article presents an overview of published experience with liver support systems since the 1960s.

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Figure 1: Timeline of the introduction of biologic and nonbiologic liver support methods.

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Authors and Affiliations

  1. Professor of Surgery and Pediatrics, Director of the Liver Transplant Program, and Chief of Transplantation,

    J Michael Millis & Julian E Losanoff

  2. Fellow of Transplantation, at the University of Chicago, Chicago, Illinois, USA

    J Michael Millis & Julian E Losanoff

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  1. J Michael Millis
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  2. Julian E Losanoff
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Correspondence to J Michael Millis.

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Millis, J., Losanoff, J. Technology Insight: liver support systems. Nat Rev Gastroenterol Hepatol 2, 398–405 (2005). https://doi.org/10.1038/ncpgasthep0254

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