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The Role of Cell-Based Bioartificial Liver Therapy in the Treatment of Fulminant Hepatic Failure

Takakazu Matsushita

Gregory J. Gores

J. Eileen Hay

Russell H. Wiesner

Alvaro A. Pineda

Dennis A. Gastineau

S. Breanndan Moore

David J. Plevak

Eelco F. Wijdicks

David G. Piepgras

Jeffrey L. Platt

Charles B. Rosen

Fulminant liver failure (FHF) is associated with a high rate of mortality. Cell-based liversupport systems have been developed for the treatment of FHF to prevent the developmentof potentially life-ending complications such as cerebral edema, intracranial hypertension,and brain herniation. Extracorporeal liver support systems, such as the bio-artificialliver (BAL), contain hepatocytes intended to provide auxiliary hepatic functionas a bridge to liver transplantation. Clinical trials indicate that the beneficial effects ofBAL therapy include a reduction of cerebral edema and intracranial pressure, along withthe possibility of spontaneous recovery in some cases. Enhancements to the BAL suchas increasing the mass of viable and metabolically active hepatocytes are likely to beassociated with greater efficacy in future clinical trials.

Key Words: fulminant hepatic failure • bioartificial liver • intracranial pressure • systemic inflammatory response syndrome

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