[Extracorporeal liver support systems].

G Azzena; E Morsiani

PubMed · 10692783

[Extracorporeal liver support systems].

Abstract

Acute liver failure is very life-threatening since the conventional medical treatments have little effects on the clinical outcome. Artificial liver support systems based on blood detoxification alone have proven ineffective because they cannot correct the severe biochemical disorders. An effective liver support system should be capable of carrying out essential functions such as phase I reaction in which lipid-soluble toxic substance are rendered water-soluble by the enzyme system of the cytochrome P450 and NADPH-cytochrome reductase, and are therefore conjugated by the phase II reaction, before excretion. Liver support systems should be capable of sustaining patients with fulminant liver failure until an organ is available for liver transplantation (bridging treatment), or improving the survival in patients for whom liver transplantation is not a therapeutic option. Recent advances in cell biology and tissue culture techniques have led the way for potential clinical use of isolated hepatocytes so that they are now an important element of bioartificial liver support devices. Some of these systems are currently under clinical investigation in the USA and Europe, and the results of the prospective controlled trials will be soon available.

Explore related subjects

Bioprosthesis Humans Liver Failure, Acute Liver, Artificial Editorial English Abstract

Keep this discovery

Explore connections, maps & timelines

BibTeX RIS

G Azzena, E Morsiani. [Extracorporeal liver support systems].. https://pubmed.ncbi.nlm.nih.gov/10692783/

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2003

Tricuspid valve replacement: an analysis of 25 years of experience at a single center.

BACKGROUND: Tricuspid valve replacement is seldom used in clinical practice, but the choice between mechanical and biologic prostheses remains controversial. METHODS: Between 1977 and 2002, 97 patients underwent tricuspid valve replacement and were followed at the Montreal Heart Institute Valve Clinic. Patients underwent replacement with bioprostheses (n = 82) and mechanical valves (n = 15). RESULTS: Patients with bioprosthetic tricuspid replacements averaged 53 +/- 13 years of age compared with 48 +/- 11 years in those with tricuspid mechanical valve replacements (p = 0.2). Isolated tricuspid valve replacement was performed in 11 patients (73%) in the mechanical valve group compared with 31 patients (38%. p = 0.01) in the bioprosthetic replacement group. In patients undergoing bioprosthetic tricuspid replacement, 51 (62%) underwent multiple associated valve replacements. The 5-year survival after tricuspid replacement averaged 60% +/- 13% in the mechanical valve group and 56% +/- 6% in the biologic replacement group (p = 0.8). The 5-year freedom rate from tricuspid valve reoperation averaged 91% +/- 9% in patients with mechanical valves and 97% +/- 3% in those with biologic valves (p = 0.2). CONCLUSIONS; Patient survival after tricuspid valve replacement is suboptimal but related to the clinical condition at operation. The use of biologic prostheses for tricuspid valve replacement remains a good option in young patients because of limited life expectancy unrelated to the type of tricuspid prostheses at long-term follow-up.

Bioprosthesis↗

PubMed2003

Premature failure of small-sized Shelhigh No-React porcine pulmonic valve conduit model NR-4000.

OBJECTIVE: Given the limited availability of small-sized cryopreserved pulmonary homografts, we implanted a series of Shelhigh No-React porcine pulmonic valve conduits (SPVC). The aim of this study was to evaluate the short-term performance following implantation. METHODS: From February 2000 to September 2000, the SPVC was implanted 25 times in 24 patients in the right ventricular outflow tract (RVOT) to correct congenital anomalies. The anatomical malformations were TOF/PA in eight patients, TGA/VSD/PS in four, truncus arteriosus in four, IAA/VSD/AS or AA in four, l-TGA/VSD in two and other in two. Age at operation was 2.8+/-3.9 years (mean+/-SD), including 12 patients under 1 year. The median conduit size was 14mm (range, 10-18). RESULTS: At a mean follow-up of 23+/-5 months, two late deaths (8%) have occurred. Although they were not primarily conduit related, both showed severe conduit stenosis. Twenty-one conduits (84%) showed mild to severe conduit stenosis, regurgitation or both. Two patients underwent balloon dilatation for distal conduit stenosis. Twelve conduits (48%) in 11 patients were removed at a median of 12 months (range, 2-18 months) due to RVOT obstruction in 11 and free conduit insufficiency with pseudoaneurysm in one. The typical findings of the explanted conduits were prominent intimal peel formation at the distal anastomosis without calcification. The actuarial freedom from reintervention at 18 months was 48+/-10%. CONCLUSIONS: Our experience of the SPVC with the diameter of 14mm or less has revealed a high incidence of distal conduit stenosis due to intimal peel formation resulting in early conduit failure. These findings have led us to abandon its use when other options are available.

Bioprosthesis↗

PubMed2003

Investigation on the mechanical properties of contracted collagen gels as a scaffold for tissue engineering.

In this article the mechanical properties of contracted collagen gels were investigated thoroughly by means of uniaxial tensile test. Large type I collagen-Dulbecco's Modified Eagle Medium (DMEM) gels (each was 26 ml in volume, 1.67 mg/ml collagen concentration), each populated with about 2.5 x 106 human fibroblasts, were made in 100 mm diameter plastic dishes precoated with albumin for floating the gels in DMEM. Such identically treated gels were divided into three groups for the mechanical measurements at different culture periods (2, 4, and 10 weeks). Rapid contraction occurred within the first 3 days and then the contraction went slowly in the rest period until it reached about 13% of its original size. The stress-strain curve of the contracted collagen gels demonstrated an exponential behavior at low stress region, followed by linear region, a point of yielding, and finally an ultimate stress point at which the maximum stress was reached. The mechanical strength increased in the first few weeks and then decreased as the culture went on. It is obvious that the collagen fibrils formed and were forced to orientate to the tensile direction after the test. The stress relaxation and cyclic creep phenomena were observed. Based on the morphological analysis of transmission electron microscopy (TEM) of the gels, a nonlinear visco-elastic-plastic constitutive formula was proposed, which was able to reproduce the rheological phenomena of the gels. This experiment shows that the human fibroblasts significantly contracted collagen gels so as to achieve certain mechanical strength, which makes it possible to be a scaffold for tissue engineering. However, a further method to reinforce the mechanical strength by several folds must be considered. Meanwhile, the rheological phenomena should be taken into account in the fabrication and application of the structure.

Bioprosthesis↗