LONG-TERM HEPATIC SUPPORT BY INTERMITTENT MULTI-SPECIES LIVER PERFUSIONS

Abstract

A patient in terminal hepato-renal failure from chronic aggressive hepatitis was brought out of coma eight times and was maintained for a period of 21/2 months, while awaiting liver transplantation, by a series of 16 extracorporeal liver perfusions from 10 pigs, 3 baboons, 1 calf, 1 monkey, and 1 human, supplemented by 20 exchange blood-transfusions. In addition to reversing coma and clearing bilirubin, these livers were shown to synthesise clotting factors, particularly factors II, V, and IX. Although exchange transfusions were equally effective in raising coagulation factors they were ineffective in restoring consciousness. Immunological studies showed that perfusion with a pig liver was followed by the development of lymphocytotoxic and anti-pig-serum antibodies which reached a maximum during the 3rd week and fell to preperfusion level later. In contrast, perfusions with baboon livers did not lead to sensitisation. Despite multiple exchange blood-transfusions and liver perfusions, leucoagglutinin and lymphocytotoxic antibodies to human cells did not develop. Clinical and biochemical data indicated that, throughout the period of hepatic support, there was almost complete absence of any intrinsic liver-cell function— making hepatic transplantation the only hope for prolonged survival. A suitable donor could not be found for this patient, who died 76 days after admission. Necropsy revealed massive hepatic-cell necrosis and collapse with early and incomplete liver regeneration.