Treatment of Hepatic Failure with ex Vivo Pig-Liver Perfusion Followed by Liver Transplantation

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Abstract
In 1990, more than 27,000 patients died of liver failure in the United States1. Perfusion through a liver from another person or a member of another species, such as a monkey, outside the body was used in the past to stabilize the condition of some patients with acute or subacute liver failure2-5. Few patients survived, however, and this approach was superseded by orthotopic liver transplantation6. Liver transplantation is associated with higher mortality for patients with fulminant hepatic failure than for patients with chronic liver disease, however. Patients with fulminant hepatic failure often have multiorgan failure and hemodynamic instability. Furthermore, many such people cannot obtain a liver within a short period because of the shortage of livers from cadavers. An artificial liver to be used outside the body, combining metabolically active pig hepatocytes and synthetic materials within a mechanical support structure, is under development7. This approach may hold promise, but only if there is a sufficient number of functioning hepatocytes.