Liver Failure Group, Institute of Hepatology, University College London Medical School, Royal Free Hospital, London, United Kingdom.
Semin Respir Crit Care Med. 2012 Feb;33(1):70-9. doi: 10.1055/s-0032-1301736. Epub 2012 Mar 23.
The realization of a support device able to effectively replace liver function in patients with hepatic failure has thus far been an elusive goal. The complexity of liver metabolic, synthetic, detoxifying, and excretory functions make artificial hepatic support extremely challenging. Currently, no specific treatment is available to reverse acute or acute-on-chronic liver failure, and morbidity and mortality of these syndromes are still high. Present management strategies are supportive, while waiting for spontaneous liver regeneration or liver transplant. Because of the scarcity of donor organs, liver support strategies are needed for patients with inadequate liver function until an appropriate organ becomes available for transplantation or until their liver recovers from injury. Currently available liver support systems comprise nonbiological systems (e.g., hemodiafiltration, albumin dialysis, and plasma exchange) and bioartificial systems utilizing viable liver cells. The role for these novel systems and their impact on survival or other clinically important outcomes are controversial. Development and use of bioartificial systems are limited by the inherent cost.
迄今为止，实现一种能够有效替代肝功能衰竭患者肝脏功能的支持装置一直是一个难以实现的目标。肝脏代谢、合成、解毒和排泄功能的复杂性使得人工肝支持极具挑战性。目前，尚无特定的治疗方法可逆转急性或慢加急性肝衰竭，这些综合征的发病率和死亡率仍然很高。目前的治疗策略是支持性的，同时等待自发的肝再生或肝移植。由于供体器官稀缺，需要肝脏支持策略来治疗肝功能不足的患者，直到有合适的器官可供移植，或者直到他们的肝脏从损伤中恢复。目前可用的肝脏支持系统包括非生物系统（如血液透析滤过、白蛋白透析和血浆置换）和利用有活力的肝细胞的生物人工系统。这些新型系统的作用及其对生存或其他临床重要结局的影响存在争议。生物人工系统的开发和使用受到固有成本的限制。
