Liver transplantation is currently the only effective therapy for patients with fulminant hepatic failure. The availability of an artificial liver could bridge these patients through the relatively brief crisis period and allow their own livers to regenerate, providing a more favorable outcome and sparing the trauma and expense of transplant. We have developed a device consisting of a highly differentiated human liver cell line cultured in a hollow fiber cartridge. This device is capable of supporting dogs with acetaminopheninduced fulminant hepatic failure for a period long enough for their own livers to resume function. Even though liver function tests such as albumin and prothrombin time became extremely abnormal during the course of the experiment, the dogs did not become encephalopathic. Two of the three treated animals recovered sufficient liver function after 42 to 48 hr of treatment that they could be disconnected from the device, and they survived the experiment. Histological results and serum ALT levels suggest that the device affected the course of the disease in two animals, allowing recovery of hepatocytes that would otherwise have lysed. In the third animal, regenerative nodules demonstrated that, even in the presence of severe liver injury, the device was capable of supporting total liver function. (HEPATOLOGY 1992;1660-65.)
Orthotopic liver transplantation has had an enormous impact on the treatment of acute and chronic liver disease (1). End-stage liver disease is routinely treated by transplantation, and the life-saving role of orthotopic liver transplantation in the treatment of fulminant hepatic failure (FHF) is now firmly established. Within this framework, the need for a liver assist device has become clear. Transplantation is often delayed for technical or medical reasons, and temporary liver support may be life sustaining during this critical period. The need is even more striking in FHF, where the