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Extracorporeal liver perfusion using human and pig livers for acute liver failure.

Publication ,  Journal Article
Horslen, SP; Hammel, JM; Fristoe, LW; Kangas, JA; Collier, DS; Sudan, DL; Langnas, AN; Dixon, RS; Prentice, ED; Shaw, BW; Fox, IJ
Published in: Transplantation
November 27, 2000

BACKGROUND: Patients with fulminant hepatic failure (FHF) often die awaiting liver transplantation. Extracorporeal liver perfusion (ECLP) has been proposed as a method of "bridging" such patients to transplantation. We report the largest experience to date of ECLP using human and porcine livers in patients with acute liver failure. METHODS: Patients with FHF unlikely to survive without liver transplantation were identified. ECLP was performed with human or porcine livers. Patients underwent continuous perfusion until liver transplantation or withdrawal of support. Two perfusion circuits were used: direct perfusion of patient blood through the extracorporeal liver and indirect perfusion with a plasma filter between the patient and the liver. FINDINGS: Fourteen patients were treated with 16 livers in 18 perfusion circuits. Nine patients were successfully "bridged" to transplantation. ECLP stabilized intracranial pressure (ICP) and cerebral perfusion pressure (CPP). Arterial ammonia levels fell from a median of 146 to 83 micromol/liter within 12 hr and this reduction was maintained at least 48 hr. Pig and human ECLP lowered ammonia levels equally. Serum bilirubin levels also fell from a median of 385 to 198 micromol/liter over the first 12 hr but the response was not sustained as well with porcine livers. There was no immunological benefit to using the the filtered perfusion circuit. INTERPRETATION: These data demonstrate that ECLP is safe and can provide metabolic support for comatose patients with fulminant hepatic failure for up to 5 days. While labor and resource intensive, this technology is available to centers caring for patients with acute liver failure and deserves wider evaluation and application.

Duke Scholars

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Published In

Transplantation

DOI

ISSN

0041-1337

Publication Date

November 27, 2000

Volume

70

Issue

10

Start / End Page

1472 / 1478

Location

United States

Related Subject Headings

  • Transplantation, Heterologous
  • Swine
  • Survival Rate
  • Surgery
  • Perfusion
  • Liver Transplantation
  • Liver Failure, Acute
  • Liver
  • Humans
  • Hepatic Encephalopathy
 

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Horslen, S. P., Hammel, J. M., Fristoe, L. W., Kangas, J. A., Collier, D. S., Sudan, D. L., … Fox, I. J. (2000). Extracorporeal liver perfusion using human and pig livers for acute liver failure. Transplantation, 70(10), 1472–1478. https://doi.org/10.1097/00007890-200011270-00014
Horslen, S. P., J. M. Hammel, L. W. Fristoe, J. A. Kangas, D. S. Collier, D. L. Sudan, A. N. Langnas, et al. “Extracorporeal liver perfusion using human and pig livers for acute liver failure.Transplantation 70, no. 10 (November 27, 2000): 1472–78. https://doi.org/10.1097/00007890-200011270-00014.
Horslen SP, Hammel JM, Fristoe LW, Kangas JA, Collier DS, Sudan DL, et al. Extracorporeal liver perfusion using human and pig livers for acute liver failure. Transplantation. 2000 Nov 27;70(10):1472–8.
Horslen, S. P., et al. “Extracorporeal liver perfusion using human and pig livers for acute liver failure.Transplantation, vol. 70, no. 10, Nov. 2000, pp. 1472–78. Pubmed, doi:10.1097/00007890-200011270-00014.
Horslen SP, Hammel JM, Fristoe LW, Kangas JA, Collier DS, Sudan DL, Langnas AN, Dixon RS, Prentice ED, Shaw BW, Fox IJ. Extracorporeal liver perfusion using human and pig livers for acute liver failure. Transplantation. 2000 Nov 27;70(10):1472–1478.

Published In

Transplantation

DOI

ISSN

0041-1337

Publication Date

November 27, 2000

Volume

70

Issue

10

Start / End Page

1472 / 1478

Location

United States

Related Subject Headings

  • Transplantation, Heterologous
  • Swine
  • Survival Rate
  • Surgery
  • Perfusion
  • Liver Transplantation
  • Liver Failure, Acute
  • Liver
  • Humans
  • Hepatic Encephalopathy