COMMENTARY

Reduced Demand, Increased Supply: Innovations Are Brightening Liver Transplantation Outcomes

The Liver Meeting 2017: American Association for the Study of Liver Diseases (AASLD)

William F. Balistreri, MD

Disclosures

December 04, 2017

In This Article

Bioartificial Liver

One additional strategy that aligns with the concept of reducing the waiting-list burden is to use support systems to aid patients with acute liver failure in hopes of allowing survival with their native liver.

Chen and colleagues[11] determined the survival benefit of a novel spheroid reservoir bioartificial liver (SRBAL) in the setting of posthepatectomy liver failure and assessed the impact on liver regeneration. The SRBAL, a novel extracorporeal liver assist device composed of functional porcine hepatocyte spheroids, is under development for supportive therapy of patients with liver failure.

Following 85% hepatectomy, pigs were randomly assigned to receive either standard therapy or combined bioartificial liver treatment without hepatocytes or with 200 g of primary porcine hepatocyte spheroids. All animals that received standard therapy or the bioartificial liver without hepatocytes (control groups) did not survive to 50 hours posthepatectomy. In contrast, 4 out of 5 animals in the SRBAL group survived to 90 hours. Their mean peak serum levels of ammonia and their peak intracranial pressure were both significantly lower than in the control animals. The ratio of liver volume at 48 hours to posthepatectomy was greatest in the SRBAL-treated group compared with the control groups.

Li and colleagues[12] evaluated the effectiveness and safety of the system in a preclinical primate model of acute liver failure. The SRBAL also improved survival rate and prolonged median survival time of monkeys. Blood ammonia and total bilirubin were lower and albumin levels were higher in all hepatocyte SRBAL treatment groups. The livers of SRBAL-treated animals showed less liver injury and accelerated regeneration compared with controls. Levels of proinflammatory cytokines (tumor necrosis factor-α, interleukin [IL]-6, IL-12, IL-1β, IL-8, interferon-γ, and IL-2) were reduced after SRBAL treatment. Other cytokines associated with liver regeneration rose transiently during SRBAL treatment.

The investigators concluded that the noted improved survival of monkeys with acute liver failure during SRBAL therapy was multifactorial and included a reduction in the hepatotoxic effect, inhibition of the proinflammatory reaction, and creation of a microenvironment more suitable for regeneration of the injured liver.

These two studies suggest that SRBAL is capable of improving survival and accelerating liver regeneration. There also was an associated neuroprotective benefit. Such favorable results warrant further clinical testing of SRBAL.

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