Rosa-Diez Guillermo, Gadano Adrián
Servicio de Nefirología Hospital Italiano, de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
Acta Gastroenterol Latinoam. 2012 Jun;42(2):135-44.
Chronic liver diseases affect 10% of the world population. Five million people per year have acute liver failure in occidental countries. Since more than 30 years now, orthotopic liver transplantation has been the treatment of choice for selected patients with these diseases, but the lack of enough organs to satisfy the increasing need oftransplantations as well as the elevated mortality of the operation in patients in critical condition, has led to search for additional therapies. Within the last years several therapies aiming to support liver function have developed in order to serve as a bridge to liver transplantation or as replace therapy allowing regeneration of the injured live. Biological and non biological devices providing liver support have been developed. The aim of this review is to analyze the technical aspects and the potential indications of the artificial non biological systems of liver support. In order to provide an adequate extracorporeal liver replacement, more complex and advanced techniques are needed, combining diffusion facilitated hemodialysis with adsorption and/or pheresis. Among these therapies, the more developed techniques are Single Pass Albumin Dialysis (SPAD), Molecular Adsorption Recirculating System (MARS) and the recently developed extracorporeal liver support combining albumin pheresis and fractioned adsorption (Prometheus).
慢性肝病影响着全球10%的人口。在西方国家，每年有500万人发生急性肝衰竭。30多年来，原位肝移植一直是这些疾病特定患者的首选治疗方法，但由于缺乏足够的器官来满足日益增长的移植需求，以及危重症患者手术死亡率较高，促使人们寻找其他治疗方法。在过去几年中，已经开发了几种旨在支持肝功能的治疗方法，以作为肝移植的桥梁或作为允许受损肝脏再生的替代疗法。已经开发了提供肝脏支持的生物和非生物装置。本综述的目的是分析人工非生物肝脏支持系统的技术方面和潜在适应症。为了提供足够的体外肝脏替代，需要更复杂和先进的技术，将促进扩散的血液透析与吸附和/或血液分离相结合。在这些治疗方法中，发展较为成熟的技术有单程白蛋白透析（SPAD）、分子吸附循环系统（MARS）以及最近开发的结合白蛋白血液分离和分级吸附的体外肝脏支持系统（Prometheus）。
