ARTIFICIAL LIVER ON ITS WAY TO CLINICAL R EALITY

Temporary extracorporeal liver assist devices based on liver cell cult ures represent a promising approach for the treatment of liver failure as well as for perioperative care in liver surgery and transplantatio n. Primary hepatocytes from donor animals as well as human cell lines have been discussed as cell sources. A viable cell mass of 110-220g ( = 2,5-5 x 10(10) liver cells) has to be functionally active in bioreac tors over a time period of several days. This cell number correlates t o 10 -20% of liver cells in an adult human liver. Neither in animal ex periments, nor in clinical trials a complete liver replacement could y et be shown for cell-based bioreactors, however beneficial effects hav e been demonstrated: partial detoxification and specific synthetic fun ctions have been reported in animal experiments. Two authors have show n first preliminary clinical data on different cell-based liver assist devices with influences on blood parameters and the neurological stat us of treated patients. Nevertheless, clinical improvements also have been achieved by using non-biological support, like charcoal-hemoperfu sion and modified hemodialysis. In order to assess the influence of li ver support devices on better results in therapy of liver failure, ran domized clinical trials have to be performed. Prior to this, artificia l liver support systems have to demonstrate their biocompatibility and biosafety for clinical use as well as their efficacy and availability .