Fox I J, Langnas A N, Fristoe L W, Shaefer M S, Vogel J E, Antonson D L, Donovan J P, Heffron T G, Markin R S, Sorrell M F
Department of Surgery, University of Nebraska Medical Center, Omaha.
Am J Gastroenterol. 1993 Nov;88(11):1876-81.
We have used extracorporeal liver perfusion (ECLP) to aid in the management of three patients with fulminant hepatic failure (FHF). Organs were used for ECLP only if they would have gone otherwise unused through United Network for Organ Sharing. In all three patients treated, serial serum bilirubin and arterial ammonia values trended toward the normal range. The neurologic examinations improved dramatically in two patients, and metabolic function of the extracorporeally perfused livers was unequivocally demonstrated by the clearance of theophylline in the last two patients. Two patients ultimately had successful liver transplants, whereas the third patient failed to improve neurologically despite evidence of metabolic function by the extracorporeally perfused liver, and died 7 days after ECLP was discontinued, from pulmonary and renal failure. These studies suggest that, 30 yr after initial clinical trials, ECLP can be applied safely without the need for arterial access 1) as a bridge to transplantation, 2) to assess whether patients in FHF will benefit from improved hepatic function and therefore transplantation, and 3) potentially, to evaluate the "usability" of questionable donor organs.
我们采用体外肝脏灌注（ECLP）来辅助治疗3例暴发性肝衰竭（FHF）患者。只有那些通过器官共享联合网络（United Network for Organ Sharing）否则将被弃用的器官才用于ECLP。在接受治疗的所有3例患者中，血清胆红素和动脉血氨值系列均趋向于正常范围。2例患者的神经学检查有显著改善，最后2例患者茶碱清除率明确显示了体外灌注肝脏的代谢功能。2例患者最终成功进行了肝移植，而第3例患者尽管体外灌注肝脏有代谢功能的证据，但神经学方面未能改善，在停止ECLP 7天后死于肺和肾衰竭。这些研究表明，在最初的临床试验30年后，无需动脉通路即可安全应用ECLP：1）作为移植的桥梁；2）评估FHF患者是否将从改善的肝功能进而从移植中获益；3）潜在地，评估可疑供体器官的“可用性”。
