Phua Jason, Lee Kang Hoe
Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore.
Curr Opin Crit Care. 2008 Apr;14(2):208-15. doi: 10.1097/MCC.0b013e3282f70057.
Liver support devices are used either as a bridge to liver transplantation or liver recovery in patients with acute or acute-on-chronic liver failure. The review analyzes the recent literature and asks if the current enthusiasm for these devices is justified.
Many liver support devices exist and are discussed. Clinical data on artificial devices are rapidly emerging, especially on the molecular adsorbents recirculating system, and fractionated plasma separation and adsorption (Prometheus). While hepatic encephalopathy is improved by the molecular adsorbents recirculating system and probably Prometheus too, neither system has been shown to improve survival. Less clinical data exist for bioartificial support devices. These may use human hepatocytes, such as the extracorporeal liver assist device, although most devices use porcine hepatocytes, such as HepatAssist.
Enthusiasm in liver support devices is justified as many nonrandomized studies have suggested some biochemical and clinical benefits. The results of several ongoing multicenter randomized controlled trials are anxiously awaited. Meanwhile, because mortality without liver transplantation remains high despite the use of liver support devices, these devices should only be used in the research setting or by experts proficient in their use and as a bridge to liver transplantation rather than liver recovery.
肝支持装置用于急性或慢性急性肝衰竭患者，作为肝移植或肝脏恢复的桥梁。本综述分析了近期文献，并探讨了当前对这些装置的热情是否合理。
存在多种肝支持装置并进行了讨论。人工装置的临床数据迅速涌现，尤其是分子吸附循环系统和分馏血浆分离与吸附（Prometheus）。虽然分子吸附循环系统可能还有Prometheus都能改善肝性脑病，但均未显示能提高生存率。生物人工支持装置的临床数据较少。这些装置可能使用人肝细胞，如体外肝辅助装置，不过大多数装置使用猪肝细胞，如HepatAssist。
许多非随机研究表明肝支持装置有一些生化和临床益处，因此对其的热情是合理的。人们急切期待正在进行的几项多中心随机对照试验的结果。同时，尽管使用了肝支持装置，但未进行肝移植时的死亡率仍然很高，所以这些装置应仅用于研究环境或由熟练使用它们的专家使用，作为肝移植而非肝脏恢复的桥梁。
