scholarly journals Extracorporeal Liver Support: A Bridge to Somewhere

2021 ◽  
Author(s):  
Abraham J. Matar ◽  
Ram Subramanian
Keyword(s):  
Liver Support ◽  
Extracorporeal Liver Support

scholarly journals Impact of anion exchange adsorbents on regional citrate anticoagulation

2020 ◽  
pp. 039139882094773
Author(s):  
Karin Strobl ◽  
Stephan Harm ◽  
Ute Fichtinger ◽  
Claudia Schildböck ◽  
Jens Hartmann
Keyword(s):  
Anion Exchange ◽  
Regional Citrate Anticoagulation ◽  
Liver Support ◽  
Anion Exchange Resins ◽  
Increased Risk ◽  
Extracorporeal Liver Support ◽  
Target Molecules ◽  
Exchange Resins ◽  
The Impact

Introduction: Heparin and citrate are commonly used anticoagulants in membrane/adsorption based extracorporeal liver support systems. However, anion exchange resins employed for the removal of negatively charged target molecules including bilirubin may also deplete these anticoagulants due to their negative charge. The aim of this study was to evaluate the adsorption of citrate by anion exchange resins and the impact on extracorporeal Ca2+ concentrations. Methods: Liver support treatments were simulated in vitro. Citrate and Ca2+ concentrations were measured pre and post albumin filter as well as pre and post adsorbents. In addition, batch experiments were performed to quantify citrate adsorption. Results: Pre albumin filter target Ca2+ concentrations were reached well with only minor deviations. Citrate was adsorbed by anion exchange resins, resulting in a higher Ca2+ concentration downstream of the adsorbent cartridges during the first hour of treatment. Conclusions: The anion exchange resin depletes citrate, leading to an increased Ca2+ concentration in the extracorporeal circuit, which may cause an increased risk of clotting during the first hour of treatment. An increase of citrate infusion during the first hour of treatment should therefore be considered to compensate for the adsorption of citrate.

Primary Human Liver Cells as Source for Modular Extracorporeal Liver Support - a Preliminary Report

2002 ◽  
Vol 25 (10) ◽  
pp. 1001-1005 ◽  
Author(s):  
I.M. Sauer ◽  
K. Zeilinger ◽  
N. Obermayer ◽  
G. Pless ◽  
A. Grünwald ◽  
...  
Keyword(s):  
Human Liver ◽  
Treatment Time ◽  
Liver Perfusion ◽  
Cell Mass ◽  
Liver Weight ◽  
Liver Cells ◽  
Liver Support ◽  
Overall Treatment Time ◽  
Human Liver Cells ◽  
Extracorporeal Liver Support

Cell-based extracorporeal liver support is an option to assist or replace the failing organ until regeneration or until transplantation can be performed. The use of porcine cells or tumor cell lines is controversial. Primary human liver cells, obtained from explanted organs found to be unsuitable for transplantation, are a desirable cell source as they perform human metabolism and regulation. The Modular Extracorporeal Liver Support (MELS) concept combines different extracorporeal therapy units, tailored to suit the individual and intra-individual clinical needs of the patient. A multi-compartment bioreactor (CellModule) is loaded with human liver cells obtained by 5-step collagenase liver perfusion. A cell mass of 400 g – 600 g enables the clinical application of a liver lobe equivalent hybrid organ. A detoxification module enables single pass albumin-dialysis via a standard high-flux dialysis filter, and continuous venovenuous hemodiafiltration may be included if required. Cells from 54 human livers have been isolated (donor age: 56 ± 13 years, liver weight: 1862 ± 556 g resulting in a viability of 55.0 ± 15.9%). These grafts were not suitable for LTx, due to steatosis (54%), cirrhosis (15%), fibrosis (9%), and other reasons (22%). Out of 36 prepared bioreactors, 10 were clinically used to treat 8 patients with liver failure. The overall treatment time was 7–144 hours. No adverse events were observed. Initial clinical applications of the bioreactor evidenced the technical feasibility and safety of the system.

scholarly journals Therapeutic plasma exchange in children with acute liver failure (ALF): is it time for incorporation into the ALF armamentarium?

2021 ◽  
Author(s):  
Emma C. Alexander ◽  
Akash Deep
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Plasma Exchange ◽  
Controlled Trial ◽  
High Volume ◽  
Systemic Circulation ◽  
Liver Support ◽  
Extracorporeal Liver Support ◽  
Randomised Controlled ◽  
Liver Assist Devices

AbstractPaediatric acute liver failure (PALF) is a rare but devastating condition with high mortality. An exaggerated inflammatory response is now recognised as pivotal in the pathogenesis and prognosis of ALF, with cytokine spill from the liver to systemic circulation implicated in development of multi-organ failure associated with ALF. With advances in medical management, especially critical care, there is an increasing trend towards spontaneous liver regeneration, averting the need for emergency liver transplantation or providing stability to the patient awaiting a graft. Hence, research is ongoing for therapies, including extracorporeal liver support devices, that can bridge patients to transplant or spontaneous liver recovery. Considering the immune-related pathogenesis and inflammatory phenotype of ALF, plasma exchange serves as an ideal liver assist device as it performs both the excretory and synthetic functions of the liver and, in addition, works as an immunomodulatory therapy by suppressing the early innate immune response in ALF. After a recent randomised controlled trial in adults demonstrated a beneficial effect of high-volume plasma exchange on clinical outcomes, this therapy was incorporated in European Association for the Study of Liver (EASL) recommendations for managing adult patients with ALF, but no guidelines exist for PALF. In this review, we discuss rationale, timing, practicalities, and existing evidence regarding the use of plasma exchange as an immunomodulatory treatment in PALF. We discuss controversies in delivery of this therapy as an extracorporeal device, and practicalities of use of plasma exchange as a ‘hybrid’ therapy alongside other extracorporeal liver assist devices, before finally reviewing outstanding research questions for the future.

Bilirubin Kinetic Modeling for Quantification of Extracorporeal Liver Support

2006 ◽  
Vol 24 (4) ◽  
pp. 413-422 ◽  
Author(s):  
Aleksandra Jung ◽  
Peter Krisper ◽  
Bernd Haditsch ◽  
Rudolf E. Stauber ◽  
Michael Trauner ◽  
...  
Keyword(s):  
Kinetic Modeling ◽  
Liver Support ◽  
Extracorporeal Liver Support

Cross-Circulation for Extracorporeal Liver Support in a Swine Model

ASAIO Journal ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Wei Kelly Wu ◽  
Andrew Tumen ◽  
John W. Stokes ◽  
Rei Ukita ◽  
Ahmed Hozain ◽  
...  
Keyword(s):  
Swine Model ◽  
Liver Support ◽  
Extracorporeal Liver Support

Extracorporeal liver support and the kidney

1998 ◽  
pp. 959-967 ◽  
Author(s):  
Norman L. Sussman ◽  
James H. Kelly
Keyword(s):  
Liver Support ◽  
Extracorporeal Liver Support

Extracorporeal liver support in patients with liver failure: a systematic review and meta-analysis of randomized trials

2019 ◽  
Vol 46 (1) ◽  
pp. 1-16 ◽  
Author(s):  
Fayez Alshamsi ◽  
◽  
Khalil Alshammari ◽  
Emilie Belley-Cote ◽  
Joanna Dionne ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Failure ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Liver Support ◽  
Extracorporeal Liver Support

scholarly journals The Fire from Within: Multiorgan Failure with Bimodal Rhabdomyolysis from Exertional Heat Stroke

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Onion Gerald V. Ubaldo ◽  
Khia Quiwa ◽  
Rohana Elise Rollan ◽  
Edhel Tripon ◽  
Elizabeth Sebastian
Keyword(s):  
Liver Transplantation ◽  
Liver Failure ◽  
Liver Transplant ◽  
Core Body Temperature ◽  
Multiorgan Failure ◽  
Heat Stroke ◽  
Exertional Heat Stroke ◽  
Liver Support ◽  
Central Nervous System Dysfunction ◽  
Extracorporeal Liver Support

Heat stroke (HS) is a condition characterized by a rise in core body temperature and central nervous system dysfunction. It is divided into two types: classical and exertional. Exertional heat stroke (EHS) is accompanied by organ failure. Liver injury, presenting only with a rise in liver enzymes, is common but in rare conditions, acute liver failure (ALF) may ensue, leading to a potentially lethal condition. Most cases of EHS-induced ALF are managed conservatively. However, liver transplantation is considered for cases refractory to supportive treatment. Identifying patients eligible for liver transplantation in the context of an EHS-induced ALF becomes a medical dilemma since the conventional prognostic criterion may be difficult to apply, and there is paucity of literature about these specific sets of individuals. Recently, extracorporeal liver support has been gaining popularity for patients with liver failure as a bridge to liver transplant. In this case report, we present a young Filipino athlete with symptoms and clinical course consistent with EHS that developed multiorgan failure, initially considered a candidate for liver transplant and total plasma exchange, but clinically improved with supportive management alone. This patient was also found to have bimodal rhabdomyolysis during the course of his hospital stay as manifested by the bimodal rise in his creatine kinase enzymes.

Advanced Technology for Extracorporeal Liver Support System Devices

2002 ◽  
Vol 25 (10) ◽  
pp. 939-949 ◽  
Author(s):  
M. Borra ◽  
D. Galavotti ◽  
C. Bellini ◽  
L. Fumi ◽  
E. Morsiani ◽  
...  
Keyword(s):  
High Volume ◽  
Mortality Rates ◽  
Advanced Technology ◽  
Main Function ◽  
Liver Support ◽  
Continuous Hemofiltration ◽  
Liver Support System ◽  
Extracorporeal Liver Support ◽  
Proven Efficacy ◽  
Biological Component

Acute Liver Failure (ALF) still presents high mortality rates, and liver transplant is the only treatment with proven efficacy. However transplant is not always possible and systems for Extracorporeal Liver Support (ELS) are being developed which can treat patients with ALF, for whom a transplant is not available, or is delayed. They can also treat patients with chronic liver disease who develop ALF. There are two types of ELS: artificial systems (hemoperfusion, plasmaperfusion, therapeutic plasma exchange, continuous hemodialysis and high volume continuous hemofiltration) and bioartificial systems. These are based on a biological component (animal or human hepatocytes) inserted into a bioreactor, whose main function is to perform the metabolic activity and synthesis that the liver can no longer perform. The results obtained in clinical trials have so far shown that the best results in terms of compensating for lost metabolic function and detoxification are obtained inserting artificial components in the bioartificial circuit.

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