DEVELOPMENT OF A HYBRID BIOARTIFICIAL LIVER

Objective The authors developed an extracorporeal liver support system and tested its efficacy in experimental animals with liver failure. T he first clinical use of this system to treat a patient with liver fai lure is reported. Summary Background Data Multiple attempts have been made, ranging from plasma exchange to use of charcoal columns, to deve lop liver support systems for treating patients with acute severe live r failure. None of these systems has achieved wide clinical use. There is a need for providing liver support as a ''bridge'' to transplantat ion and for treating patients with potentially reversible liver dysfun ction. Methods A hybrid liver support system has been developed consis ting of plasma perfusion through a charcoal column and a porous hollow fiber module inoculated with 5 X 10(9) matrix-attached hepatocytes. T he system was tested in dogs with ischemic liver failure (n = 7) who u nderwent plasmapheresis; a control group (n = 6) underwent charcoal pe rfusion alone. A patient with liver failure was treated with this hybr id system. Results After 6 hours of hybrid liver support treatment, an imals had significantly decreased serum ammonia and lactate levels, in creased glucose level, normal prothrombin time, and increased systolic blood pressure compared with controls treated with charcoal perfusion alone. Use of the system to treat a patient was well tolerated with e vidence of clinical improvement. Conclusions Plasma perfusion through a system consisting of a charcoal column and matrix-attached porcine h epatocytes had significant beneficial effects in animals with liver fa ilure and was well tolerated by a patient with liver failure.