Jinyang Gu1,2, Xiaolei Shi1,2, Haozhen Ren1, Qingxiang Xu1,2, Jun Wang3, Jiangqiang Xiao1, Yitao Ding4,5. 1. Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China. 2. Jiangsu Province's Key Medical Center for Hepatobiliary Disease, Nanjing, China. 3. Department of Hepatobiliary Surgery, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China. 4. Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China. yitaoding@hotmail.com. 5. Jiangsu Province's Key Medical Center for Hepatobiliary Disease, Nanjing, China. yitaoding@hotmail.com.
Abstract
BACKGROUND: Orthotopic liver transplantation (OLT) is the only effective long-term treatment for liver failure by now. However, it is not yet a perfect choice due to donor-organ shortage and the need of a lifelong immunosuppressive therapy. Therefore, it is necessary to find a new approach to fighting the disease. Several published clinical trials have reported the therapeutic effect of bio-artificial liver (BAL) for liver failure. OBJECTIVE: To overview and evaluate the current clinical application and outcomes of extracorporeal BAL support system during the past 15 years. METHODS: Relevant studies were retrieved from PubMed and Cochrane Library databases. Independent assessments and the final consensus decision were performed by three independent reviewers. Acceptable study designs included randomized controlled trials, controlled clinical trials, and case reports. A total of 31 studies were tabulated and critically appraised in terms of characteristics, methods, and outcomes. RESULTS: There was a trend of falling into the normal ranges with the clinical and biochemical parameters after the BAL treatment. The neurological status of most patients was improved or stabilized during BAL treatment as well. No significant effect on survival could be seen after the BAL treatment. CONCLUSIONS: Although BAL system proved to be a success in some clinical cases reported, it still needs to be improved greatly.
BACKGROUND: Orthotopic liver transplantation (OLT) is the only effective long-term treatment for liver failure by now. However, it is not yet a perfect choice due to donor-organ shortage and the need of a lifelong immunosuppressive therapy. Therefore, it is necessary to find a new approach to fighting the disease. Several published clinical trials have reported the therapeutic effect of bio-artificial liver (BAL) for liver failure. OBJECTIVE: To overview and evaluate the current clinical application and outcomes of extracorporeal BAL support system during the past 15 years. METHODS: Relevant studies were retrieved from PubMed and Cochrane Library databases. Independent assessments and the final consensus decision were performed by three independent reviewers. Acceptable study designs included randomized controlled trials, controlled clinical trials, and case reports. A total of 31 studies were tabulated and critically appraised in terms of characteristics, methods, and outcomes. RESULTS: There was a trend of falling into the normal ranges with the clinical and biochemical parameters after the BAL treatment. The neurological status of most patients was improved or stabilized during BAL treatment as well. No significant effect on survival could be seen after the BAL treatment. CONCLUSIONS: Although BAL system proved to be a success in some clinical cases reported, it still needs to be improved greatly.
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