目的总结慢性重症乙型肝炎肝移植治疗的临床经验。方法对23例慢性重症乙型肝炎肝移植患者的临床资料及随访结果进行回顾性分析。结果23例患者术前肝功能均为Child C级，23例中术前出现肾功能指标异常13例（56.5%），不同程度肝性脑病10例（43.5%），肺部及腹腔感染6例（26.1%），肝肾综合征9例（39.1%），消化道出血3例（13.0%），乙肝病毒活跃复制状态14例（60.9%）。全组围手术期死亡（术后30 d内死亡）6例（26.1%）。术后主要并发症： 肺部感染14例（60.9%），多器官功能衰竭（MOF）9例（39.1%），未出现原发性肝无功能及血管系统并发症。1年生存率为70.6%。结论慢性重症乙型肝炎肝移植治疗可获得满意的临床效果和生存质量。
The main treatment strategies for hepatic failure include drug therapy, artificial liver support system, and liver transplantation. This article introduces the clinically commonly used non biological artificial liver techniques, including plasma exchange, continuous blood purification, plasma bilirubin adsorption, plasma diafiltration, repeatedly pass albumin dialysis, molecular adsorbent recirculating system, Prometheus system, etc; and discusses how to select different artificial liver techniques according to different clinical manifestation. At the same time, the progress of bioartificial liver in recent years is summarized, and the future development of artificial liver is prospected.
【Abstract】Objective To evaluate effect of artificial liver support system (ALSS) in liver failure and liver transplantation.Methods Forty-four patients with liver failure (including 12 undergoing liver transplantation) were treated with MARS or plasma exchange. The changes of toxic substances and cytokines in blood were detected before and after treatment. Results ALSS therapy achieved a remarkable improvement in clinical symptoms and physical signs. After ALSS treatment, there was a significant decrease in total bilirubin, total bile acid, alanine aminotransferase, creatinine, urea nitrogen, blood ammonia and endotoxin levels(P＜0.05); the levels of serum NO, TNF-α, IL-4 and IL-6 were significantly decreased(P＜0.05); there was no statistical change in erythrocytes, leukocytes and platelets. The survival rate of 30 liver failure patients caused by severe hepatitis B was 60.0%(18/30). Six patients with acute liver failure were successfully performed liver transplantation. Two patients in 6 with acute liver failure after liver transplantation survived. One patient in 2 with acute liver failure after pancreatoduodenectomy survived. Conclusion ALSS plays a positive role in treatment of liver failure by removing blood toxins, NO and cytokines. ALSS also plays a substitute role for liver failure patients who are waiting for liver transplantation.
ObjectiveTo provide theoretical and technological support for further study of liver metabolism and disease by comparing the advantages and disadvantages of various artificial liver models (biological). MethodsLiteratures were searched and compared to summarize the requirement for liver donor, isolation, and culture of hepatocyte. ResultsIn the separation method of hepatocyte, mechanical separation method had no requirement for liver donor, and was easy to acquire hepatocyte, while the acquired hepatocyte would be destructed severely, and the survival rate was low. On the other hand, the restriction of the digestion of the hepatocytes to the liver cell samples was unlimited, while the key of the enzyme digestion method was to regulate the balance between enzyme concentration and digestion time, which was limited to function researches of hepatocyte, and research about the responds of hepatocyte against outside, and other few researches. Perfusion digestion method had been widely applied for animal test. The Ca2+, collagenase and perfusion rate, pH value, buffer, and intubation method all play vital roles. During the cultivation, we needed to choose different methods according to several experiments, and add different additives in the appropriate medium. Different biological reactors had different advantages, disadvantages, and applicable conditions. ConclusionsThe donor selection is based on various experimental purposes to harvest hepatocytes from different sources. Whether on the separation process or on the cultivation process, according to the specific circumstances, such as the concentration, perfusion time, and the choice of different kinds of culture medium, we can choose different kinds of bioreactors, but all kinds of methods are still remained with multiple insufficiencies, which require more researchers to improve.
Understanding the mass transfer behaviors in hollow fiber membrane module of artificial liver is important for improving toxin removal efficiency. A three-dimensional numerical model was established to study the mass transfer of small molecule bilirubin and macromolecule bovine serum albumin (BSA) in the hollow fiber membrane module. Effects of tube-side flow rate, shell-side flow rate, and hollow fiber length on the mass transfer of bilirubin and BSA were discussed. The simulation results showed that the clearance of bilirubin was significantly affected by both convective and diffusive solute transport, while the clearance of macromolecule BSA was dominated by convective solute transport. The clearance rates of bilirubin and BSA increasd with the increase of tube-side flow rate and hollow fiber length. With the increase of shell-side flow rate, the clearance rate of bilirubin first rose rapidly, then slowly rose to an asymptotic value, while the clearance rate of BSA gradually decreased. The results can provide help for designing structures of hollow fiber membrane module and operation parameters of clinical treatment.
Bioartificial liver support system (BALSS) provides a new way to treat liver failure and leaves more time for patients who are waiting for liver transplantation. It has detoxification function as well as the human liver, at the same time it can provide nutrition and improve the internal environment inside human body. Bioreactors and hepatocytes with good biological activity are the cores of BALSS which determine the treatment effect. However, in the course of prolonged treatment, the function and activity of hepatocytes might be greatly changed which could influence the efficacy. Therefore, it is very important to detect the status of the hepatocytes in BALSS. This paper presents some common indicators of cell activity, detoxification and synthetic functions, and also introduces the commonly detection methods corresponding to each indicator. Finally, we summarize the application of detection methods of the hepatocyte status in BALSS and discuss its development trend.
ObjectiveTo learn the outcomes of hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) cases after artificial liver support system (ALSS) treatment and the relevant factors correlated with the clinical outcomes. MethodsIn the period from January 2011 to June 2014, 321 patients with HBV-ACLF were admitted to West China Hospital. The clinical data at baseline, before and after treatment were analyzed by univariate and multivariate logistic regressions to identify the independent risk factors correlated with 30-day outcomes. ResultsOf all the 321 patients, 233 survived and 88 died by the end of a 30-day observation. The univariate analysis identified that the incidences of cirrhosis, hepatorenal syndrome and peritonitis in the death group were significantly higher (P<0.05). The model for end-stage liver disease values, white blood cells (WBC), blood ammonia, creatinine and total bilirubin (TBIL) at different stages in the death group were significantly higher than those in the survival group (P<0.05). In the death group, the HBV-DNA, TBIL decrease after triple ALSS treatments, baseline prothrombin time activity (PTA) and PTA level after triple ALSS treatments were significantly lower (P<0.05). The multivariate logistic regression indicated that WBC (OR=2.337, P<0.001) and TBIL level after triple ALSS treatments (OR=4.935, P<0.001) were independent predicting factors for death within 30 days after ALSS treatment; HBV-DNA (OR=0.403, P<0.001), the decrease of TBIL after triple ALSS treatments (OR=0.447, P<0.001) and PTA level after triple ALSS treatments (OR=0.332, P<0.001) were protecting factors for the 30-day prognosis. ConclusionThese five factors including WBC, HBV-DNA, PTA, TBIL and TBIL decrease after triple ALSS treatments influence the short-term prognosis for HBV-ACLF patients, which are valuable for decision making in clinical practices.