Horslen S P, Hammel J M, Fristoe L W, Kangas J A, Collier D S, Sudan D L, Langnas A N, Dixon R S, Prentice E D, Shaw B W, Fox I J
Department of Pediatric Gastroenterology and Nutrition, University of Nebraska Medical Center, Omaha 68198-3285, USA.
Transplantation. 2000 Nov 27;70(10):1472-8. doi: 10.1097/00007890-200011270-00014.
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 with acute liver failure.
Patients with FHF unlikely to survive without liver transplantation were identified. ECLP was performed with human or porcine 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.
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 micromol/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 micromol/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 the filtered perfusion circuit.
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.
暴发性肝衰竭（FHF）患者常于等待肝移植期间死亡。体外肝灌注（ECLP）已被提议作为将此类患者“过渡”至移植的一种方法。我们报告了迄今为止在急性肝衰竭患者中使用人肝和猪肝进行ECLP的最大规模经验。
确定了若不进行肝移植则不太可能存活的FHF患者。使用人肝或猪肝进行ECLP。患者接受持续灌注直至肝移植或停止支持治疗。使用了两种灌注回路：患者血液直接通过体外肝脏进行灌注，以及在患者与肝脏之间使用血浆滤器进行间接灌注。
14例患者在18个灌注回路中使用了16个肝脏进行治疗。9例患者成功“过渡”至移植。ECLP稳定了颅内压（ICP）和脑灌注压（CPP）。动脉血氨水平在12小时内从中位数146微摩尔/升降至83微摩尔/升，且这种降低至少维持了48小时。猪肝和人肝的ECLP降低血氨水平的效果相同。血清胆红素水平在最初12小时内也从中位数385微摩尔/升降至198微摩尔/升，但猪肝的反应维持时间不如人肝。使用过滤灌注回路并无免疫方面的益处。
这些数据表明，ECLP是安全的，可为暴发性肝衰竭昏迷患者提供长达5天的代谢支持。尽管这项技术需要大量人力和资源，但对于治疗急性肝衰竭患者的中心来说是可行的，值得更广泛的评估和应用。
