Extracorporeal liver perfusion using human and pig livers for acute liver failure.
Extracorporeal liver perfusion using human and pig livers for acute liver failure.
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DOI：
10.1097/00007890-200011270-00014
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发表时间：
2000-11-27
期刊：
影响因子：
6.2
通讯作者：
Fox, IJ
中科院分区：
文献类型：
--
作者：
Horslen, SP;Hammel, JM;Fox, IJ
背景暴发性肝功能衰竭（FHF）患者在等待肝移植时经常死亡。体外肝灌注（ECLP）已被提出作为一种“桥接”这些患者移植的方法。我们报告了迄今为止使用人类和猪肝进行ECLP治疗急性肝衰竭患者的最大经验。FHF患者不经肝移植不太可能存活。用人或猪肝进行ECLP。患者接受持续灌注，直至肝移植或撤回支持。使用了两种灌注回路：通过体外肝脏直接灌注患者血液，以及在患者和肝脏之间使用血浆过滤器间接灌注。14例患者在18个灌注回路中使用16个肝脏进行治疗。9名患者成功地“桥接”到移植。ECLP稳定颅内压（ICP）和脑灌注压（CPP）。动脉氨水平下降，从146至83 μ mol/L的中位数在12小时内，这种减少至少维持48小时。猪和人ECLP降低氨水平相同。血清胆红素水平也从中位数385下降到198 mumol/升，在第一个12小时，但响应不持续，以及与猪肝。使用过滤的灌注回路没有免疫学益处。这些数据表明，ECLP是安全的，可以为暴发性肝衰竭昏迷患者提供长达5天的代谢支持。虽然劳动力和资源密集型，但这项技术可用于治疗急性肝衰竭患者的中心，值得更广泛的评估和应用。
Background. Patients with fulminant hepatic failure (FHF) often die awaiting liver transplantation. Extracorporeal liver perfusion (ECLP) has been proposed as a method of "bridging" such patients to transplantation. We report the largest experience to date of ECLP using human and porcine livers in patients withy acute liver failure.Methods. Patients with FHF unlikely to survive without liver transplantation were identified. ECLP was performed with human or procine livers. Patients underwent continuous perfusion until liver transplantation or withdrawal of support. Two perfusion circuits were used: direct perfusion of patient blood through the extracorporeal liver and indirect perfusion with a plasma filter between the patient and the liver.Findings. Fourteen patients were treated with 16 livers in 18 perfusion circuits. Nine patients were successfully "bridged" to transplantation. ECLP stabilized intracranial pressure (ICP) and cerebral perfusion pressure (CPP). Arterial ammonia levels fell from a median of 146 to 83 mumol/liter within 12 hr and this reduction was maintained at least 48 hr. Pig and human ECLP lowered ammonia levels equally. Serum bilirubin levels also fell from a median of 385 to 198 mumol/liter over the first 12 hr but the response was not sustained as well with porcine livers. There was no immunological benefit to using the filtered perfusion circuit.Interpretation. These data demonstrate that ECLP is safe and can provide metabolic support for comatose patients with fulminant hepatic failure for up to 5 days. While labor and resource intensive, this technology is available to centers caring for patients with acute liver failure and deserves wider evaluation and application.