Abstract
Purpose of the study: The use of bioartificial liver (BAL) has been reported to be an optimal temporary support until liver transplantation for patients affected by fulminant hepatic failure. At present data on cases of acute exacerbation of chronic liver disease are less encouraging since no clear neurological improvement have been reported yet. The use of higher number of hepatocytes and of hollow-fiber with greater porosity might help to improve results in these cases. Methods used: A 57 year old man with an acute exacerbation of chronic liver disease related to HBV infection, grade 3 potto-systemic encephalopathy, insulin dependent diabetes and renal failure was admitted to the surgical ICU in hepatic coma [Glasgow Coma Scale (GCS)=6]. EEG evaluation at admission revealed a diffuse metabolic neurological distress. BAL procedure, using cryopreserved porcine hepatocytes, was performed every 48 hours for 3 times. Briefly, 1,5±1010 viable porcine hepatocytes and 10g hydrated collagen coated dextran microcarriers were loaded into the extrafiber space of a hollow-fiber bioreactor (0,6μm porosity). Patient underwent plasmapheresis and plasma recirculated through an activated cellulose-charcoal column, an oxygenator, a heater and finally through the bioreactor loaded with porcine hepatocytes. Treatments lasted 6 hours. Results: patient tolerated the procedure very well, cardiovascular and pulmonary functions were not altered. At the end of the last treatment the patient recovered from coma conditions. Glasgow Coma Scale improved to 11. Amelioration of neurological status was confirmed by EEG evaluation that revealed a improvement in the basic neurological activity with reduction of Δ waves. These results suggest that repeated BAL procedures using higher number of hepatocytes and a large porosity hollow fiber has been well tolerated and resulted in temporary neurological improvement in a patient with acute on chronic liver failure.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
