ARTIFICIAL LIVER SUPPORT - THE PIPE DREAM OF TODAY SHOULD BE THE REALITY OF THE NEAR FUTURE

The title of this article is taken from an interesting Letter to the E ditor entitled 'Artificial liver support - Pipe dream or reality' by C attral and Levy of the Toronto Hospital, Canada, published in the New England Journal of Medicine 1994, in which the authors persuasively pr opose possibilities of artificial liver support and suggest its advant ages. We find that their suggestions agree with the core of our though ts on this subject. The present article deals with the concept of impl anting livers taken from humans, primates or nonprimates (e.g. hog) in to patients in parallel with their own metabolically fatigued or cirrh otic livers, with minimal surgical manipulation, as a prelude to total artificial liver support via a liver dialysis device. While the possi bility exists that the host liver may recover function, a donor liver, whether implanted into the patient's abdomen or connected in vitro to the patient's circulatory system extracorporeally, may provide the ho st liver respite and a period for recovery and proliferation, if possi ble. Once recovery is under way, the donor liver may be removed and th e patient will not experience the usual risks of rejection and the nec essary side-effects of immunosuppression associated with conventional full hepatectomy and donor transplantation. The viability of a liver i mplantation model in rats is correlated in this article with hepatic a cute phase response.