Artificial Liver Support

Continuing progress has been made since the first edition of Artificial Liver Support was published. Liver transplantation has however become an estab lished therapy for a relatively small number of patients who remain patients for life. There therefore continues to be a great need for the development of other forms of artificial liver support. Improved intensive care utilizing improved plasma exchange, dialysis, sclerotherapy, and intracranial pressure monitoring have improved survival in fulminant hepatic failure. Progress has also been made in lipid membrane detoxification, in cell cultures, and in cell transplantation, and the isolation of various liver cell growth factors has led to deep insight into the mechanisms of liver regeneration. This book gives the clinician and the researcher detailed information about established new methods of clinic work and laboratory research, and describes new experimental approaches indicating the direction of future research. G. BRUNNER M. Mno Preface to the First Edition The regenerative capacity of the liver cell is almost unlimited. Therefore after acute liver damage, be it viral, toxic, hypoxic, or surgical in origin, restitutio ad integrum is the usual outcome. In two forms of liver disease, however, this is not the case: in fulminant hepatic failure, liver regeneration often is not fast enough to keep the organism alive; in end-stage cirrhosis, regeneration is disturbed by a hypertrophic architecture of fibrotic tissue. For these extreme forms of liver disease and for critical situations before and after liver surgery, artificial liver support is needed.

For years clinicians and scientists have been trying to improve the treatment of acute hepatic failure. Hemodialysis procedures were refined. The treatment of fulminant hepatic failure and end-stage liver cirrhosis by liver transplantation became a standard procedure. For the successful management of critical situations before and after liver surgery, artificial liver support is required. An overview is provided of the possibilities and limitations of the existing procedures and devices available for artificial liver support. The results achieved with albumin dialysis, the Prometheus System, and dialysis and hemofiltration or plasma exchange, as well as modular extracorporeal liver support and the Amsterdam bioartificial liver, and their effects are discussed. The book addresses the remaining problems and expectations for the future of clinical hepatocyte transplantation and stem cell therapy. An exceptional overview of the problems and future perspectives in the field of artificial liver support.

Continuing progress has been made since the first edition of Artificial Liver Support was published. Liver transplantation has however become an estab lished therapy for a relatively small number of patients who remain patients for life. There therefore continues to be a great need for the development of other forms of artificial liver support. Improved intensive care utilizing improved plasma exchange, dialysis, sclerotherapy, and intracranial pressure monitoring have improved survival in fulminant hepatic failure. Progress has also been made in lipid membrane detoxification, in cell cultures, and in cell transplantation, and the isolation of various liver cell growth factors has led to deep insight into the mechanisms of liver regeneration. This book gives the clinician and the researcher detailed information about established new methods of clinic work and laboratory research, and describes new experimental approaches indicating the direction of future research. G. BRUNNER M. Mno Preface to the First Edition The regenerative capacity of the liver cell is almost unlimited. Therefore after acute liver damage, be it viral, toxic, hypoxic, or surgical in origin, restitutio ad integrum is the usual outcome. In two forms of liver disease, however, this is not the case: in fulminant hepatic failure, liver regeneration often is not fast enough to keep the organism alive; in end-stage cirrhosis, regeneration is disturbed by a hypertrophic architecture of fibrotic tissue. For these extreme forms of liver disease and for critical situations before and after liver surgery, artificial liver support is needed.

This book introduces the clinical application of artificial liver system (ALS) in hepatic failure. It has been widely used in clinics aiming to provide temporary support of liver function while maintaining extra-hepatic function in patients with liver failure. This work comprehensively summarizes the progress of livers and artificial liver, for example, the principle and implementation of Li-ALS, cell transplantation and the combined application of artificial liver and liver transplantation. It will be helpful for clinicians to implement artificial liver treatment to save the lives of patients with hepatic failure.

In this book, members of the Cedars-Sinai Medical Center, Liver Support Unit (LSU) present the most current understanding of the pathophysiology of liver failure and how its various forms and manifestations are classified, and summarize the state of the art in the diagnosis and management of the disease.