Samuel Didier, Ichai Philippe, Feray Cyrille, Saliba Faouzi, Azoulay Daniel, Arulnaden Jean Louis, Debat Pierre, Gigou Michelle, Adam René, Bismuth Alain, Castaing Denis, Bismuth Henri
Centre Hépatobiliaire, UPRES 1596, Equipe INSERM 99-41, Assistance Publique-Hôpitaux de Paris, Université Paris Sud, Hôpital Paul Brousse, Villejuif, France.
Transplantation. 2002 Jan 27;73(2):257-64. doi: 10.1097/00007890-200201270-00019.
Brain edema is the main cause of death in acute liver failure patients awaiting transplantation. We assessed the HepatAssist 2000, a liver-assist system containing porcine hepatocytes, as a bridge to transplantation in patients with acute liver failure.
Thirteen patients suffering from acute liver failure with criteria for transplantation entered an open baseline-controlled study, with liver-assist treatment sessions at 24-hr intervals until transplantation. Neurological status was regularly evaluated using the Glasgow Coma Scale.
Three patients were not treated: one had an immediate transplantation and two improved spontaneously. Ten patients received one to three courses of HepatAssist. A significant neurological improvement (mean Glasgow Coma Scale before and after treatment: 6.5+/-3.7 and 9.6+/-4.4, respectively, P<0.02) was observed, which was related to the volume of plasma processed per square meter of body surface. A significant decrease was observed in mean levels of bilirubin (P=0.0005) and transaminases but not in the other indicators of liver function. Six patients had transient episodes of hemodynamic instability, and five had bleeding complications. Two patients died after transplantation. Eight patients survived with a mean follow-up of 24.3 (18-32) months.
The HepatAssist 2000 is well tolerated, improves cerebral function, and may be used as a bridge to transplantation for patients with liver failure.
脑水肿是等待肝移植的急性肝衰竭患者死亡的主要原因。我们评估了HepatAssist 2000,一种含有猪肝细胞的肝辅助系统,作为急性肝衰竭患者肝移植的桥梁。
13例符合移植标准的急性肝衰竭患者进入一项开放的基线对照研究,每隔24小时进行一次肝辅助治疗,直至移植。使用格拉斯哥昏迷量表定期评估神经状态。
3例患者未接受治疗:1例立即接受移植,2例自发好转。10例患者接受了1至3个疗程的HepatAssist治疗。观察到神经功能有显著改善(治疗前后格拉斯哥昏迷量表平均分分别为6.5±3.7和9.6±4.4,P<0.02),这与每平方米体表面积处理的血浆量有关。胆红素(P=0.0005)和转氨酶平均水平显著下降,但肝功能的其他指标未下降。6例患者出现短暂的血流动力学不稳定,5例出现出血并发症。2例患者移植后死亡。8例患者存活,平均随访24.3(18 - 32)个月。
HepatAssist 2000耐受性良好,可改善脑功能,可作为肝衰竭患者肝移植的桥梁。