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Extracorporeal Cellular Liver Assisted Devices

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Liver Diseases

Abstract

The current definitive management of acute liver failure and acute on chronic liver failure is liver transplantation. However, because of organ shortages, other modalities of therapy are necessary as a possible bridge. This chapter discusses the current state of extracorporeal cellular (bioartificial) liver assist devices including Extracorporeal Liver Assist Device (ELAD), HepatAssist, Modular Extracorporeal Liver Support System (MELS), and the Bioartificial Liver Support System (BLSS). An overview of the circuit as well as outcomes of studies done using these devices will be provided.

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References

  1. Jepsen P, Ott P, Andersen PK, Sørensen HT, Vilstrup H. Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study. Hepatology. 2010;51:1675. https://doi.org/10.1002/hep.23500.

    Article  PubMed  Google Scholar 

  2. Rahman H. Review article: liver support systems in acute hepatic failure. Aliment Pharmacol Ther. 1999;13(10):1255–72. https://doi.org/10.1046/j.1365-2036.1999.00597.x.

    Article  CAS  PubMed  Google Scholar 

  3. Riordan SM, Williams R. Extracorporeal support and hepatocyte transplantation in acute liver failure and cirrhosis. J Gastroenterol Hepatol. 1999;14(8):757–70. https://doi.org/10.1046/j.1440-1746.1999.01945.x.

    Article  CAS  PubMed  Google Scholar 

  4. Allen JW, Hassanein T, Bhatia SN. Advances in bioartificial liver devices. Hepatology. 2001;34(3):447–55. https://doi.org/10.1053/jhep.2001.26753.

    Article  CAS  PubMed  Google Scholar 

  5. Keeffe EB. Liver transplantation: current status and novel approaches to liver replacement. Gastroenterology. 2001;120(3):749–62. https://doi.org/10.1053/gast.2001.22583.

    Article  CAS  PubMed  Google Scholar 

  6. Pless G. Artificial and bioartificial liver support. Organogenesis. 2007;3:20. https://doi.org/10.4161/org.3.1.3635.

    Article  PubMed  PubMed Central  Google Scholar 

  7. van Wenum M, Chamuleau RA, van Gulik TM, Siliakus A, Seppen J, Hoekstra R. Bioartificial livers in vitro and in vivo : tailoring biocomponents to the expanding variety of applications. Expert Opin Biol Ther. 2014;14:1745. https://doi.org/10.1517/14712598.2014.950651.

    Article  CAS  PubMed  Google Scholar 

  8. Leckie P, Davenport A, Jalan R. Extracorporeal liver support. Blood Purif. 2012;34(2):158–63. https://doi.org/10.1159/000342065.

    Article  PubMed  Google Scholar 

  9. Chen HS, Nyberg SL. Acute liver failure and bioartificial liver support. 8th ed. Amsterdam: Elsevier Inc.; 2018. https://doi.org/10.1016/B978-0-323-40232-3.00128-X.

    Book  Google Scholar 

  10. Thompson J, Jones N, Al-Khafaji A, et al. Extracorporeal cellular therapy (ELAD) in severe alcoholic hepatitis: a multinational, prospective, controlled, randomized trial. Liver Transpl. 2018;24:380. https://doi.org/10.1002/lt.24986.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gislason GT, Lobdell DD, Kelly JH, Sussman NL. A treatment system for implementing an extracorporeal liver assist device. Artif Organs. 1994;18(5):385–9. https://doi.org/10.1111/j.1525-1594.1994.tb02220.x.

    Article  CAS  PubMed  Google Scholar 

  12. Tritto G, Davies N, Jalan R. Liver replacement therapy. Semin Respir Crit Care Med. 2012;33:70. https://doi.org/10.1055/s-0032-1301736.

    Article  PubMed  Google Scholar 

  13. Millis JM, Cronin DC, Johnson R, et al. Initial experience with the modified extracorporeal liver-assist device for patients with fulminant hepatic failure: system modifications and clinical impact. Transplantation. 2002;74(12):1735–46. https://doi.org/10.1097/01.TP.0000038483.93833.21.

    Article  PubMed  Google Scholar 

  14. Ellis AJ, Hughes RD, Wendon JA, et al. Pilot-controlled trial of the extracorporeal liver assist device in acute liver failure. Hepatology. 1996;24(6):1446–51. https://doi.org/10.1053/jhep.1996.v24.pm0008938179.

    Article  CAS  PubMed  Google Scholar 

  15. Sussman NL, Kelly JH. Improved liver function following treatment with an extracorporeal liver assist device. Artif Organs. 1993;17:27. https://doi.org/10.1111/j.1525-1594.1993.tb00381.x.

    Article  CAS  PubMed  Google Scholar 

  16. Duan Z, Xin S, Zhang J, et al. Comparison of extracorporeal cellular therapy (ELAD) vs standard of care in a randomized controlled clinical trial in treating Chinese subjects with acute-on-chronic liver failure. Hepatic Med Evid Res. 2018;10:139–52. https://doi.org/10.2147/HMER.S180246.

    Article  Google Scholar 

  17. Landeen LK, Lapetoda J, Bedard PW, et al. Sa1449 - inflammation biomarkers decrease during ELAD treatment in alcoholic hepatitis subjects. Gastroenterology. 2018;154(6):S–1117. https://doi.org/10.1016/S0016-5085(18)33716-8.

    Article  Google Scholar 

  18. Demetriou AA, Brown RS, Busuttil RW, et al. Prospective, randomized, multicenter, controlled trial of a bioartificial liver in treating acute liver failure. Ann Surg. 2004;239(5):660–70. https://doi.org/10.1097/01.sla.0000124298.74199.e5.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Watanabe FD, Mullon CJ, Hewitt WR, et al. Clinical experience with a bioartificial liver in the treatment of severe liver failure. A phase I clinical trial. Ann Surg. 1997;225(5):484–91-4. https://doi.org/10.1097/00000658-199705000-00005.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Sauer IM, Kardassis D, Zeillinger K, et al. Clinical extracorporeal hybrid liver support--phase I study with primary porcine liver cells. Xenotransplantation. 2003;10:460–9. https://doi.org/10.1034/j.1399-3089.2003.00062.x.

    Article  CAS  PubMed  Google Scholar 

  21. Gerlach JC, Encke J, Hole O, Müller C, Ryan CJ, Neuhaus P. Bioreactor for a larger scale hepatocyte in vitro perfusion. Transplantation. 1994;58:984. https://doi.org/10.1097/00007890-199411150-00002.

    Article  CAS  PubMed  Google Scholar 

  22. Sauer IM, Zeilinger K, Pless G, et al. Extracorporeal liver support based on primary human liver cells and albumin dialysis - treatment of a patient with primary graft non-function. J Hepatol. 2003;39:649. https://doi.org/10.1016/S0168-8278(03)00348-9.

    Article  PubMed  Google Scholar 

  23. Sauer IM, Zeilinger K, Obermayer N, et al. Primary human liver cells as source for modular extracorporeal liver support--a preliminary report. Int J Artif Organs. 2002;25:1001.

    Article  CAS  PubMed  Google Scholar 

  24. Patzer JF, Mazariegos GV, Lopez R, et al. Novel bioartificial liver support system: preclinical evaluation. Ann N Y Acad Sci. 1999;875:340–52. https://doi.org/10.1111/j.1749-6632.1999.tb08516.x.

    Article  PubMed  Google Scholar 

  25. Mazariegos GV, Patzer JF, Lopez RC, et al. First clinical use of a novel Bioartificial Liver Support System (BLSS). Am J Transplant. 2002;2(3):260–6. https://doi.org/10.1034/j.1600-6143.2002.20311.x.

    Article  PubMed  Google Scholar 

  26. Mazariegos GV, Kramer DJ, Lopez RC, et al. Safety observations in Phase I clinical evaluation of the excorp medical bioartificial liver support system after the first four patients. ASAIO J. 2001;47(5):471–5. https://doi.org/10.1097/00002480-200109000-00015.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Nikolaos T. Pyrsopoulos .

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Self Study

Self Study

1.1 Question

  1. 1.

    Which statement is true?

    1. (a)

      ELAD employs the use of porcine hepatocytes

    2. (b)

      MELS employs the use of only porcine hepatocytes

    3. (c)

      HepatAssist employs the use of porcine hepatocytes

    4. (d)

      BLSS uses plasma for exchange

1.2 Answer

  1. 1.

    Which statement is true?

    1. (a)

      ELAD uses human hepatoblastoma cells not porcine hepatocytes

    2. (b)

      MELS uses both porcine and human hepatocytes

    3. (c)

      CORRECT ANSWER. HepatAssist uses porcine hepatocytes

    4. (d)

      BLSS uses whole blood for exchange not plasma

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Patel, P., Pyrsopoulos, N.T. (2020). Extracorporeal Cellular Liver Assisted Devices. In: Radu-Ionita, F., Pyrsopoulos, N., Jinga, M., Tintoiu, I., Sun, Z., Bontas, E. (eds) Liver Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-24432-3_67

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  • DOI: https://doi.org/10.1007/978-3-030-24432-3_67

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  • Online ISBN: 978-3-030-24432-3

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