Molecular adsorbent recycling system in treating patients with acute liver failure: a bridge to liver transplantation.

BACKGROUND: Acute liver failure is still a life-threatening disease although it can be treated by liver transplantation. This study was conducted to assess the molecular adsorbent recycling system (MARS), which may bridge acute liver failure patients to liver transplantation. METHODS: Biochemical indexes and other clinical data were analyzed of 8 patients with acute liver failure, who had been treated by MARS for 34 times and subsequent Piggyback liver transplantation. RESULTS: After treatment with MARS, the levels of transaminase and total bilirubin decreased markedly, but coagulation function remained unimproved. All patients survived and discharged from the hospital. CONCLUSION: MARS is effective in bridging patients with acute liver failure to liver transplantation.

A reliable graded acute liver failure model in rats: treatment with internal bioartificial liver.

BACKGROUND: Appropriate animal models are important for studying acute liver failure. This study was to assess a new suitable rat model for acute liver failure. METHODS: After the right influent hepatic vessels were clamped for a period of time (45, 60 or 90 minutes respectively), the animal model was established by removal of the clamp for restoring blood flow of the right lobes while immediately removal of the median, left lateral and caudate lobes. Animal survival rate was observed in the following 14 days in each group. To study the pathophysiological changes of the model, some biochemical parameters in 5 consecutive days were evaluated in the 60-minute group. Internal bioartificial liver was transplanted in the peritoneal cavity to test the reversibility of the model. RESULTS: The survival rate of the models decreased, as the ischemia time of the right lobes prolonged to zero in the 90-minute group, to 50% in the 60-minute group and to 100% in the 45-minute group on the fifth day after operation. The levels of ammonia, alanine aminotransferase, alkaline phosphatase, total bilirubin and prothrombin were elevated dramatically 12 to 24 hours after operation in the 60-minute group. When internal bioartificial liver was transplanted, the survival rate increased significantly in addition to the levels of ammonia and total bilirubin. CONCLUSION: A period time of ischemic injury in the right lobe followed by 70% liver resection can produce a graded acute hepatic failure model in rats.

The development of a new bioartificial liver and its application in 12 acute liver failure patients.

AIM: Bioartificial liver is a hope of supporting liver functions in acute liver failure patients. Using polysulfon fibers, a new bioartificial liver was developed. The aim of this study was to show whether this bioartificial liver could support liver functions or not. METHODS: Hepatocytes were procured from swine using Seglen's methods. The bioartificial liver was constructed by polysulfon bioreactor and more than 10(10) hepatocytes. It was applied 14 times in 12 patients, who were divided into 7 cases of simultaneous HBAL and 5 cases of non-simultaneous HBAL. Each BAL treatment lasted 6 hours. The general condition of the patients and the biochemical indexes were studied. RESULTS: After treatment with bioartificial liver, blood ammonia, prothrombin time and total bilirubin showed significant decrease. 2 days later, blood ammonia still showed improvment. within one month period, 1 case (1/7) in simultaneous group died while in non-simultaneous group 2 cases (2/5) died. The difference was significant. Mortality rate was 25 %. CONCLUSION: The constructed bioartificial liver can support liver functions in acute liver failure. The simultaneous HBAL is better than non-simultaneous HBAL.

Non-bleeding technique in resection of hepatoma: report of 49 cases.

OBJECTIVE: To investigate the experience and some related problems of non-bleeding technique in partial hepatectomy. METHODS: 49 cases of hepatic tumors were reviewed, including 41 cases of hepatic carcinoma, 3 cases of secondary hepatic carcinoma, 4 cases of haemangioma, and 1 case of hepatic adenoma. Three kinds of bleeding control technique including normothermic complete hepatic vascular exclusion (47/49), complete vascular isolation with hypothermic perfusion (1/49), and partial extracorporeal hepatectomy (1/49) were employed. RESULTS: The intraoperative volume of blood loss was 1560+/-1252 ml, and operative duration was 4.7+/-0.8 h. One case died perioperatively because of severe bleeding. 31 cases of primary hepatic carcinoma were followed up, the 0.5-, 1-, and 5-year survival rates were 77% (24/31), 55% (17/31), and 36% (11/31) respectively. CONCLUSIONS: In liver surgery concerning hepatoma in the segment of Couinaud I, IV, V or VIII, Pringle's procedure is still the major method for bleeding control. When the vena cava or/and venae hepaticae was/were implicated, normothermic complete hepatic vascular exclusion is helpful. The partial extracorporeal technique can provide a good exposure to the cava inferior, and is an alternative to the complete extracorporeal method. Intraoperative B ultrasound detection plays an important role in choosing bleeding control technique.