In vivo experience with an extracorporeal flat-plate bioartificial liver: demonstration of efficacy in treating fulminant hepatic failure

An extracorporeal bioartificial liver (BAL) device has the potential to provide temporary support for patients with fulminant hepatic failure (FHF). The authors developed a flat-plate BAL with an internal membrane oxygenator in which porcine hepatocytes were cultured as a monolayer. The efficacy of this device was tested in an experimental animal model of FHF. Twenty-four hours after cannulation of the left carotid artery and right jugular vein, FHF was induced in rats by administering two intraperitoneal injections of D-galactosamine (GalN) (1.2 g/kg) at a 12 hour interval. The rats were connected to a BAL device 24 hours after the first GalN injection, and underwent extracorporeal perfusion for a duration of 10 hours. Liver-specific markers and animal survival up to 168 hours (7 days) were examined. Significant reductions occurred in the plasma ammonia levels and prothrombin times in the group treated with the seeded BAL device. Animal survival in the group treated with the seeded BAL device was significantly higher (50.0%) than in the control animal group treated with an unseeded BAL device (11.1%). In conclusion, this flat-plate BAL with an internal membrane oxygenator and cultured porcine hepatocytes has yielded encouraging results in the treatment of rats with GalN-induced FHF.