Rozga J, Holzman M D, Ro M S, Griffin D W, Neuzil D F, Giorgio T, Moscioni A D, Demetriou A A
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
Ann Surg. 1993 May;217(5):502-9; discussion 509-11. doi: 10.1097/00000658-199305010-00010.
The authors developed an extracorporeal liver support system and tested its efficacy in experimental animals with liver failure. The first clinical use of this system to treat a patient with liver failure is reported.
Multiple attempts have been made, ranging from plasma exchange to use of charcoal columns, to develop liver support systems for treating patients with acute severe liver failure. None of these systems has achieved wide clinical use. There is a need for providing liver support as a "bridge" to transplantation and for treating patients with potentially reversible liver dysfunction.
A hybrid liver support system has been developed consisting of plasma perfusion through a charcoal column and a porous hollow fiber module inoculated with 5 x 10(9) matrix-attached hepatocytes. The system was tested in dogs with ischemic liver failure (n = 7) who underwent plasmapheresis; a control group (n = 6) underwent charcoal perfusion alone. A patient with liver failure was treated with this hybrid system.
After 6 hours of hybrid liver support treatment, animals had significantly decreased serum ammonia and lactate levels, increased glucose level, normal prothrombin time, and increased systolic blood pressure compared with controls treated with charcoal perfusion alone. Use of the system to treat a patient was well tolerated with evidence of clinical improvement.
Plasma perfusion through a system consisting of a charcoal column and matrix-attached porcine hepatocytes had significant beneficial effects in animals with liver failure and was well tolerated by a patient with liver failure.
作者研发了一种体外肝脏支持系统，并在肝功能衰竭实验动物中测试了其疗效。本文报道了该系统首次临床用于治疗一名肝功能衰竭患者的情况。
为研发用于治疗急性重症肝功能衰竭患者的肝脏支持系统，人们进行了多种尝试，从血浆置换到使用活性炭柱等不一而足。但这些系统均未得到广泛临床应用。需要提供肝脏支持作为移植的“桥梁”，并治疗具有潜在可逆性肝功能障碍的患者。
已研发出一种混合肝脏支持系统，该系统由通过活性炭柱的血浆灌注和接种了5×10⁹个基质附着肝细胞的多孔中空纤维模块组成。该系统在接受血浆置换的缺血性肝功能衰竭犬（n = 7）中进行了测试；对照组（n = 6）仅接受活性炭灌注。一名肝功能衰竭患者接受了该混合系统治疗。
与仅接受活性炭灌注治疗的对照组相比，混合肝脏支持治疗6小时后，动物的血清氨和乳酸水平显著降低，血糖水平升高，凝血酶原时间正常，收缩压升高。该系统用于治疗患者时耐受性良好，有临床改善的证据。
通过由活性炭柱和基质附着猪肝细胞组成的系统进行血浆灌注，对肝功能衰竭动物有显著有益效果，且肝功能衰竭患者耐受性良好。
