Auxiliary liver transplantation and bioartificial bridging procedures in treatment of acute liver failure

被引：0
作者：
Boudjema K. [1 ]
Bachellier P. [2 ]
Wolf P. [2 ]
Tempé J.-D. [3 ]
Jaeck D. [2 ]
机构：
[1] Departement de Chirurgie Viscerale, Hopital Universitaire Pontchaillou, 35033 Rennes
[2] Centre de Chirurgie Viscérale, Hopital Universitaire de Hautepierre, 67098 Strasbourg
[3] Service de Reanimation Medicale, Hopital Universitaire de Hautepierre, 67098 Strasbourg
来源：
World Journal of Surgery | 2002年 / 26卷 / 2期
关键词：
Liver Transplantation; Liver Failure; Acute Liver Failure; Auxiliary Liver Transplantation;
D O I：
10.1007/s00268-001-0215-0
中图分类号：
学科分类号：
摘要：
The aim of this review is to discuss the place of auxiliary liver transplantation (ALT) and other cellular based bridging procedures such as hepatocyte transplantation, ex vivo liver perfusion, and bioartificial livers, in the treatment of acute liver failure, vis à vis conventional orthotopic liver transplantation. Hepacocyte transplantation, and ex vivo pig or human liver perfusion are still experimental procedures. Bioartificial livers using human tumoral hepatocytes or porcine hepatocytes have been used in clinical situations as a bridge to transplantation, i.e. to gain the time required to find a high-quality graft for conventional or auxiliary liver transplantation. None of these techniques have yet proved capable of keeping a patient alive long enough for the native liver to recover. Conversely, ALT has been shown to be effective in the treatment of acute liver failure and now appears to be a satisfactory bridging procedure pending native liver (NL) regeneration. We report personal experience of 18 ALT procedures performed in 17 patients between October 1992 and December 1999. The ALT procedure was indicated when patients met criteria for conventional transplantation; it was ultimately selected when a fresh frozen biopsy of the NL did no show any fibrosis. Six patients died within the first 2 postoperative months. The remaining 11 patients are alive, with a follow-up ranging from 2 to 7 years. Regeneration of the NL occurred in 11 of the 17 patients (65%) and in 8 of the 11 survivors (72%), 6 of whom have permanently stopped immunosuppressive therapy. We conclude that liver failure should no longer be handled outside centers where all types of transplantation can be offered, and where innovative therapies such as hepatocyte transplantation and extracorporeal liver-assist devices are being developed and evaluated.
引用
收藏
页码：264 / 274
页数：10
相关论文
共 42 条
[1]  
O'Grady J.G., Facteurs pronostiques de l'insuffisance hépatique aiguë et indications de transplantation hépatique, Insuffisance Hépatique Aiguë Grave et Réanimation, pp. 189-201, (1993)
[2]  
Bismuth H., Samuel D., Gugenheim J., Castaing D., Bernuau J., Rueff B., Benhamou J.P., Emergency liver transplantation for fulminant hepatitis, Ann. Intern. Med., 107, (1987)
[3]  
Peleman R.R., Gavaler J.S., Van Thiel D.H., Esquivel C., Gordon G., Iwatzuki S., Starzl T.E., Orthotopic liver transplantation for acute and subacute hepatic failure in adults, Hepatology, 7, (1987)
[4]  
Vickers C., Neuberger J., Buckels J., McMaster P., Elias E., Transplantation of the liver in adults and children with fulminant hepatic failure, J. Hepatol., 7, (1988)
[5]  
Devictor D., Desplanques L., Debray D., Ozier B., Dubousset A.M., Valayer J., Houssin D., Emergency liver transplantation for fulminant liver failure in infants and children, Hepatology, 16, (1992)
[6]  
Haller M., Schonfelder R., Briegel J., Pratschke E., Spengler U., Pfeiffer M., Forst H., Finsterer U., Renal function in the postoperative period after orthotopic liver transplantation, Transplant. Proc., 24, (1992)
[7]  
London N.J., Farmery S.M., Will E.J., Davison A.M., Lodge J.P., Risk of neoplasia in renal transplant patients, Lancet, 346, (1995)
[8]  
Marion P., Betroye A., Mikaeloff P., Bolot J.F., Essai de traitement du coma hépatique par hétérogreffe auxiliaire, Mem. Acad. Chir., 96, (1970)
[9]  
Galmari D., Riquier G., Vercesi G., Coma hépatique: Expérimentation de traitement dans deux cas avec greffe hétérotopique temporaire du foie, Acta Chir. Belg., 71, (1972)
[10]  
Pouyet Y., Berard P., Deux cas de transplantation hétérotopique vraie de foie de babouin au cours d'hépatites aiguës malignes, Lyon Chir., 67, (1971)
12345