End-stage liver failure: filling the treatment gap at the intensive care unit
| Autor: | Ruurdtje Hoekstra, Robert A. F. M. Chamuleau |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Nephrology
medicine.medical_specialty Cell Transplantation medicine.medical_treatment Biomedical Engineering Medicine (miscellaneous) Review Liver transplantation law.invention Biomaterials End Stage Liver Disease 03 medical and health sciences 0302 clinical medicine law Internal medicine Detoxification medicine Acute on chronic liver failure Animals Humans Artificial liver Intensive care medicine Plasma Exchange business.industry Mesenchymal stem cell Plasmapheresis Intensive care unit Liver Artificial Transplantation Clinical trial Intensive Care Units 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Liver function Cardiology and Cardiovascular Medicine business Acute liver failure |
| Zdroj: | Journal of Artificial Organs |
| ISSN: | 1619-0904 1434-7229 |
| Popis: | End-stage liver failure is a condition of collapsing liver function with mortality rates up to 80. Liver transplantation is the only lifesaving therapy. There is an unmet need for therapy to extend the waiting time for liver transplantation or regeneration of the native liver. Here we review the state-of-the-art of non-cell based and cell-based artificial liver support systems, cell transplantation and plasma exchange, with the first therapy relying on detoxification, while the others aim to correct also other failing liver functions and/or modulate the immune response. Meta-analyses on the effect of non-cell based systems show contradictory outcomes for different types of albumin purification devices. For bioartificial livers proof of concept has been shown in animals with liver failure. However, large clinical trials with two different systems did not show a survival benefit. Two clinical trials with plasma exchange and one with transplantation of mesenchymal stem cells showed positive outcomes on survival. Detoxification therapies lack adequacy for most patients. Correction of additional liver functions, and also modulation of the immune system hold promise for future therapy of liver failure. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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