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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A bioartificial liver device (BAL) is an artificial extracorporeal supportive device for an individual who is suffering from acute liver failure.

Use

The purpose of BAL-type devices, currently, is not to permanently replace liver functions, but to serve as a supportive device,[1] either allowing the liver to regenerate properly upon acute liver failure, or to bridge the individual's liver functions until a transplant is possible.

Function

BALs are essentially bioreactors, with embedded hepatocytes (liver cells) that perform the functions of a normal liver. They process oxygenated blood plasma, which is separated from the other blood constituents.[2] Several types of BALs are being developed, including hollow fiber systems and flat membrane sheet systems.[3]

Hollow fiber system

One type of BAL is similar to kidney dialysis systems that employ a hollow fiber cartridge. Hepatocytes are suspended in a gel solution, such as collagen, which is injected into a series of hollow fibers. In the case of collagen, the suspension is then gelled within the fibers, usually by a temperature change. The hepatocytes then contract the gel by their attachment to the collagen matrix, reducing the volume of the suspension and creating a flow space within the fibers. Nutrient media is circulated through the fibers to sustain the cells. During use, a patient's blood is fed into the space surrounding the fibers. The fibers, which are composed of a semi-permeable membrane, facilitate transfer of toxins, nutrients and other chemicals between the blood and the suspended cells. The membrane also keeps immune bodies, such as immunoglobulins, from passing to the cells to prevent an immune system rejection. [4]

Comparison to liver dialysis

The advantages of using a BAL, over other dialysis-type devices (e.g. liver dialysis), is that metabolic functions (such as lipid and plasma lipoprotein synthesis, regulation of carbohydrate homeostasis, production of serum albumin and clotting factors, etc.), in addition to detoxification, can be replicated without the use of multiple devices. There are currently several BAL devices currently in clinical trials.

A series of studies in 2004 showed that a BAL device reduced mortality by about half in acute liver failure cases [5]. The studies, which covered 171 patients in the U.S. and Europe, compared standard supportive care to the use of a bioreactor device using pig liver cells.

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References

  1. Allen J, Hassanein T, Bhatia S (2001). "Advances in bioartificial liver devices". Hepatology. 34 (3): 447–55. PMID 11526528.  Free Full Text.
  2. Strain A, Neuberger J (2002). "A bioartificial liver--state of the art". Science. 295 (5557): 1005–9. PMID 11834813. 
  3. Current Work on the Bioartificial Liver
  4. University of Minnesota Bioartificial Liver: How it Works
  5. Major study: Bioartificial liver reduces mortality by 44 percent in acute liver-failure patients

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