Artificial Liver

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.

There is a rapid increase in interest related to novel approaches in artificial kidneys, artificial liver, and detoxifi cation. Recent research has included the successful clinical appli cations of the principle of artificial cells for adsorbent hemo perfusion. Since it is 20 years ago at McGill that the first report on "Artificial Cells" was presented, I thought it might be useful to get together a small group of speakers and participants for a day before the ASAIO meeting to discuss some recent advances in the area of the clinical applications of artificial kidney, artificial liver and artificial cells with emphasis on adsorbent hemoperfusion. However, the enthusiastic supports of distinguished speakers, session chairmen and participants were such that the original pro jection of 100 participants had expanded to a preregistration total of 250, from Australia, Canada, England, France, Germany, Israel, Italy, Japan, The Netherlands, Scotland, Sweden and U. S. A. The program also expanded to include a review section on hemodialysis, dialysate regeneration, hemofiltration, resin hemoperfusion and oxystarch given by their respective originators. The remaining of the symposium emphasizes the status of the art on different encap sulated adsorbent hemoperfusion approaches. I would like to apolo gize to those who we could not accommodate beca~se of space limita tions. It is hoped that this symposium volume may be useful for them and for others who are interested in this area. Special thanks are due to Ms Joanne Toms for her excellent secretarial assistance for the conference and Mrs.

This 1997 text is a guide to acute liver failure aetiology, pathology and treatment.