Objective To summarize clinical application status of auxiliary heterotopic liver transplantation. Methods Reviewed relevant literatures and made a summary. Indications, contraindications, surgical treatment, therapeutic efficacy, and existing problems of auxiliary heterotopic liver transplantation were summed up. Results Main indication of auxiliary heterotopic liver transplantation is fulminant liver failure, and with no absolute contraindications. Partial liver transplantation is more popular. The therapeutic efficacy of auxiliary heterotopic liver transplantation is confirmed, but there are still some problems needed to be solved. Conclusion Auxiliary heterotopic liver transplantation is an effective method and replacement therapy for acute and chronic liver failure.
【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 retrospective analysis the research progress of the acute-on-chronic liver failure (ACLF), and provide some useful advice for the early diagnosis, evaluation, and treatments of ACLF. MethodsThe literatures on ACLF which published in domestic and overseas for these years were reviewed. ResultsACLF, which is an acute deterioration of liver function results from precipitating events in patients with chronic liver disease. As an independent clinical entity and different from acute liver failure (ALF), sub-acute liver failure (SALF), and chronic liver failure (CLF). For the high short-term mortality and seldom good treatment measures, attached much people's attention. ConclusionThe research of ACLF makes great advance but still exits different in some field between the East and the West. Search dangerous etiology earlier, combine with reality and early effective treatments can develop total survival rate of ACLF.
Hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) has the characteristics of rapid progress and high mortality. Artificial liver support system (ALSS) is far superior to standard drug therapy in the treatment of such patients, and is widely used in emergency. ALSS is the use of external mechanical or biological devices to replace a part of the damaged liver function, divided into bioartificial, non-bioartificial liver and a combination of the two. At present, there is no unified sensitive prognostic index and recognized prognostic model for HBV-ACLF in artificial liver treatment. This paper reviews the research progress of prognosis evaluation of ALSS in the treatment of HBV-ACLF, in order to provide reference for clinicians and researchers