Pascher Andreas, Sauer Igor M, Hammer Claus, Gerlach Joerg C, Neuhaus Peter
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Charité, Campus Virchow-Klinikum der Humboldt Universität zu Berlin, Berlin, Germany.
Xenotransplantation. 2002 Sep;9(5):309-24. doi: 10.1034/j.1399-3089.2002.01076.x.
There are almost no prospective, controlled and randomized clinical trials comparing different approaches towards hepatic assist. In order to create a basis for comparing the value of the existing different hepatic assist methods this article offers a systematic review of the world experience with allogeneic or xenogeneic extracorporeal liver perfusion (ECLP).
An Internet-assisted search was conducted in the international literature published from 1964 to 2000. Only articles with a clear description of methodology and outcome of patients were included. For multivariate analysis of variance the general linear method (GLM) procedure was used. Differences within the groups were analyzed by chi-square test. Data of 198 patients were included into the statistical analysis for systematic review.
The long-term survival rate (SVR) of these patients was 26%, thus not exceeding published data concerning SVR under standard intensive care. Age below 40 years (P<0.029), coma stage lower than III-IV (P<0.003), total perfusion time over 10 hours (P<0.024), hepatitis B as cause for acute liver failure (ALF) (P<0.05) as well as use of baboon and human livers (P<0.02) were identified as independent positive prognostic markers for improved survival. ECLP as bridging therapy to liver transplantation was successful in 12 of 14 patients.
ECLP using pig livers did not surpass the success of conventional intensive care treatment. An additional effect of transgenic expression of human regulators of complement regulation in porcine livers has not yet been proven. ECLP with human livers not suitable for liver transplantation might prove effective and practicable for temporary hepatic support. Bridging to liver transplantation by long-term ECLP using porcine and human livers appears to have comparable efficacy as bioartificial support methods.
几乎没有前瞻性、对照和随机临床试验来比较不同的肝辅助方法。为了为比较现有不同肝辅助方法的价值奠定基础，本文对同种异体或异种体外肝灌注（ECLP）的全球经验进行了系统综述。
在1964年至2000年发表的国际文献中进行了互联网辅助搜索。仅纳入对患者方法和结果有清晰描述的文章。对于多变量方差分析，使用了一般线性方法（GLM）程序。组内差异通过卡方检验进行分析。198例患者的数据纳入系统综述的统计分析。
这些患者的长期生存率（SVR）为26%，因此未超过标准重症监护下关于SVR的已发表数据。40岁以下（P<0.029）、昏迷阶段低于III-IV级（P<0.003）、总灌注时间超过10小时（P<0.024）、乙型肝炎作为急性肝衰竭（ALF）的病因（P<0.05）以及使用狒狒和人肝脏（P<0.02）被确定为生存改善的独立阳性预后标志物。ECLP作为肝移植的桥接治疗在14例患者中的12例中取得成功。
使用猪肝的ECLP未超过传统重症监护治疗的成功率。猪肝脏中人类补体调节因子转基因表达的额外效果尚未得到证实。使用不适用于肝移植的人肝脏进行ECLP可能被证明对临时肝支持有效且可行。使用猪和人肝脏通过长期ECLP桥接肝移植似乎与生物人工支持方法具有相当的疗效。
