EXTRACORPOREAL LIVER SUPPORT - APPLICATION TO FULMINANT HEPATIC-FAILURE

Artificial liver support is urgently needed. Mechanical devices such a s hemodialysis and hemoperfusion do not correct the metabolic abnormal ities that exist in endstage liver disease, and biologically active de vices have been impracticable because of limitations in the availabili ty and viability of cultured liver cells. This deficit in the medical armamentarium is a major concern best illustrated by current managemen t of fulminant hepatic failure (FHF). Medical treatment for FHF is lar gely unsuccessful, and orthotopic liver transplantation (OLT) is the i ntervention against which all future therapeutic interventions must be judged. The OLT procedure, however, is not benign. The cast is high, and survivors face a lifetime of immunosuppression and medical supervi sion. By comparison, patients who survive without surgery recover full liver function and have a normal life expectancy. A device that provi des liver support during the critical stages of FHF would stabilize pa tients until a suitable donor organ was found and might negate the nee d for transplant altogether if the liver were able to regenerate. We r eview theoretical and practical aspects of biologically active devices using FHF as a paradigm of liver disease.