TREATMENT OF HEPATIC COMA BY EXTRACORPOREAL PIG-LIVER PERFUSION

Abstract

Four patients in hepatic coma were treated by repeated extracorporeal pig-liver perfusions after failing to respond to standard medical treatment. One patient recovered consciousness completely after one perfusion, while the remainder showed lightening of coma or neurological improvement. In all patients perfusions were followed by a striking fall in blood-ammonia, bilirubin, and clotting-time together with a rise in prothrombin and fibrinogen. All patients had complications such as cessation of respiration, hypoglycæmia, anuria, and hæmorrhage and they died 8, 5, 8, and 10 days from onset of coma. The average rate of survival from acute hepatic necrosis treated by conventional methods is about 10%; with exchange blood-transfusions it is 20%, and with extracorporeal liver perfusions about 18%. The use of extracorporeal liver is a safe and rational method of temporary hepatic support since, with good technique, such a liver can carry out the metabolic functions of a normal liver. Ultimate survival depends on the extent of the initial hepatic necrosis, on the rate of liver regeneration, and on the absence of certain lethal complications. Survival could be improved if standard treatment is combined with liver perfusion early and vigorously. While liver transplantation may be helpful for the treatment of encephalopathy due to cirrhosis, it is of doubtful value in cases of acute hepatic necrosis, particularly when caused by viral hepatitis.