Clinical use of a bioartificial liver in the treatment of acetaminophen-induced fulminant hepatic failure

Patients with aeetaminophen-induced fulminant hepatic failure (FHF) who mee t the King's College Hospital criteria have a high mortality risk (>90%)if they do not undergo liver transplantation. We have developed a treatment st rategy for these patients based on the use of an extracorporeal bioartifici al liver (BAL) support system. In this study, we report the results of the clinical application of BAL support in patients with acetaminophen-induced FHF. All patients were admitted to a dedicated surgical intensive care unit . They were evaluated for urgent liver transplantation and received the sta ndard medical measures, including N-acetylcysteine administration and intra cranial pressure monitoring. Moreover, they underwent daily 6-hour BAL trea tments. Eight patients were treated. Three patients were bridged to liver t ransplantation, and five patients recovered without a transplant. All patie nts experienced neurological and metabolic improvement after treatments wit h the BAL support system. The BAL support system seems to improve the outco me of high-risk patients with acetaminophen-induced FHF, even in the absenc e of liver transplantation. Avoiding liver transplantation is particularly important in an era of organ shortage and high cost of transplants.