Prospects for an artificial liver

Abstract

The normal liver provides many complex and important activities. These include: (1) carbohydrate, amino acid, and fatty acid metabolism; (2) serum protein synthesis; (3) vitamin storage; (4) biliary excretion; and (5) detoxification. Fortunately many of these hepatic activities can be partially provided parenterally such as with total parenteral nutrition and clotting factor replacement. Of the activities of the liver required for survival that do not have a satisfactory alternative, detoxification is unique and for this reason, it should be one of the primaly objectives in the replacement of hepatic activities. Artificial liver support (ALS) can be defined as an artificial replacement of liver function using either an extracorporeal or an implantable device. Our efforts have been directed primarily in the development of an extracorporeal device that could be used in liver failure analogous to the use of renal dialysis systems in renal failure. ALS systems could be used in acute fulminant hepatic failure to support liver function while the liver regenerates or is replaced. ALS could also provide support in chronic liver failure, particularly when combined with orthotopic liver transplantation. While awaiting liver transplantation, ALS could improve the overall condition of the patient until a compatible liver could be obtained and ALS could assist hepatic function perioperatively for liver transplantation or during temporary hepatic graft dysfunction or rejection.