Carpentier B, Gautier A, Legallais C
UTC, UMR CNRS 6600 Biomechanics and Bioengineering, BP 20529, 60205 Compiègne Cedex, France.
Gut. 2009 Dec;58(12):1690-702. doi: 10.1136/gut.2008.175380.
Liver failure is associated with high morbidity and mortality without transplantation. There are two types of device for temporary support: artificial and bioartificial livers. Artificial livers essentially use non-living components to remove the toxins accumulated during liver failure. Bioartificial livers have bioreactors containing hepatocytes to provide both biotransformation and synthetic liver functions. We review here the operating principles, chemical effects, clinical effects and complications of both types, with specific attention paid to bioartificial systems. Several artificial support systems have FDA marketing authorisation or are CE labelled, but the improvement they provide in terms of patient clinical outcome has not yet been fully demonstrated. At present, different bioartifical systems are being investigated clinically on the basis of their promises and capacity to provide and replace most liver functions. However, important issues such as cost, cell availability, maintenance of cell viability and functionality throughout treatment, and regulatory issues, as well as difficult challenges, including implementing cell-housing devices at the patient's bedside on an emergency basis, have delayed their appearance in intensive care units and on the market. Bioreactors are, nevertheless, when combined with artificial components, a pragmatic approach for future treatment of liver failure.
在不进行肝移植的情况下，肝衰竭与高发病率和高死亡率相关。有两种用于临时支持的装置：人工肝和生物人工肝。人工肝主要使用无生命的组件来清除肝衰竭期间积累的毒素。生物人工肝具有包含肝细胞的生物反应器，以提供生物转化和肝脏合成功能。我们在此回顾这两种类型的工作原理、化学作用、临床效果和并发症，特别关注生物人工系统。几种人工支持系统已获得美国食品药品监督管理局（FDA）的上市许可或带有CE标志，但它们在患者临床结局方面所提供的改善尚未得到充分证实。目前，不同的生物人工系统正在基于其提供和替代大多数肝脏功能的前景及能力进行临床研究。然而，诸如成本、细胞可用性、在整个治疗过程中维持细胞活力和功能以及监管问题等重要问题，以及包括在紧急情况下在患者床边实施细胞容纳装置等艰巨挑战，都延迟了它们在重症监护病房的应用和上市。尽管如此，生物反应器与人工组件相结合，仍是未来治疗肝衰竭的一种务实方法。
