García Martínez Juan José, Bendjelid Karim
Intensive Care Unit, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland.
Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Ann Intensive Care. 2018 Nov 15;8(1):109. doi: 10.1186/s13613-018-0453-z.
The liver is a complex organ that performs vital functions of synthesis, heat production, detoxification and regulation; its failure carries a highly critical risk. At the end of the last century, some artificial liver devices began to develop with the aim of being used as supportive therapy until liver transplantation (bridge-to-transplant) or liver regeneration (bridge-to-recovery). The well-recognized devices are the Molecular Adsorbent Recirculating System™ (MARS™), the Single-Pass Albumin Dialysis system and the Fractionated Plasma Separation and Adsorption system (Prometheus™). In the following years, experimental works and early clinical applications were reported, and to date, many thousands of patients have already been treated with these devices. The ability of artificial liver support systems to replace the liver detoxification function, at least partially, has been proven, and the correction of various biochemical parameters has been demonstrated. However, the complex tasks of regulation and synthesis must be addressed through the use of bioartificial systems, which still face several developmental problems and very high production costs. Moreover, clinical data on improved survival are conflicting. This paper reviews the progress achieved and new data published on artificial liver support systems over the past decade and the prospects for these devices.
肝脏是一个执行合成、产热、解毒和调节等重要功能的复杂器官；肝脏衰竭具有极高的风险。上世纪末，一些人工肝装置开始研发，旨在用作肝移植（过渡到移植）或肝脏再生（过渡到恢复）之前的支持性治疗。广为人知的装置有分子吸附再循环系统™（MARS™）、单程白蛋白透析系统和分级血浆分离吸附系统（普罗米修斯™）。在随后的几年里，有实验研究和早期临床应用的报道，迄今为止，已有数千名患者接受了这些装置的治疗。人工肝支持系统至少部分替代肝脏解毒功能的能力已得到证实，并且已证明其能纠正各种生化参数。然而，调节和合成等复杂任务必须通过使用生物人工系统来解决，而生物人工系统仍面临若干发展问题且生产成本极高。此外，关于提高生存率的临床数据存在矛盾之处。本文回顾了过去十年人工肝支持系统所取得的进展和新发表的数据以及这些装置的前景。
