J Korean Soc Transplant.  2011 Mar;25(1):15-21. 10.4285/jkstn.2011.25.1.15.

Artificial Liver Devices and Bioartificial Liver Systems: Current Status

• Kwon CH
• Lee SK
• Park JK
• Lee DH
• Lee JH

• KMID: 2202344
• DOI: http://doi.org/10.4285/jkstn.2011.25.1.15

Abstract

Acute liver failure is a rapidly progressive disease of the liver associated with high morbidity and mortality without liver transplantation. Although good survival after transplantation can be achieved, due to the disparity between patients awaiting transplantation and available organs, many patients die due to progression of the disease while waiting for a liver graft. To reduce the high morbidity and mortality associated with acute liver failure, attempts have been made during the last several decades to develop a temporary liver support system, such as artificial and bioartificial livers. The artificial liver is a non-biological device mainly aimed at the removal of accumulated toxins during liver failure, and the bioartificial liver is a biological device that has bioreactors containing living hepatocytes which provide both biotransformation and synthetic liver functions. There are currently 3 artificial livers available in the market that have been actively used in the clinical field, and 11 bioartificial livers that have been developed and have undergone clinical trials. In this article, we will discuss about the 3 artificial liver devices and 5 bioartificial liver systems that are the most advanced and have been widely evaluated clinically. Also, the characteristics and the preclinical data of the first bioartificial liver system developed in Korea that is currently under clinical investigation, will be discussed.

Keyword

Bioartificial liver; Artificial liver; Acute liver failure; Calcium alginate; Hepatic transplantation

MeSH Terms

Alginates
Bioreactors
Biotransformation
Glucuronic Acid
Hepatocytes
Hexuronic Acids
Humans
Korea
Liver
Liver Failure
Liver Failure, Acute
Liver Transplantation
Liver, Artificial
Transplants
Alginates
Glucuronic Acid
Hexuronic Acids

Figure

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  Fig. 1. Schematic illustration of Molecular Absorbent Recirculating System (MARS) (A) and Prometh-eus (B).

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  Fig. 2. Schematic illustration of Extracorporeal Liver Assist Device (ELAD). The plasma is separated using ultrafiltrate generator and the ultrafiltrate is circulated to 4 parallel cartilages containing C3A cells.

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  Fig. 3. Schematic illustration of Modular Extracorporeal Liver Support (MELS) device. It consists of a detoxification module performing single pass albumin dialysis, hemofiltration module and a bioreactor that contains 3 bundles of hollow fiber membrane interwoven into a three-dimensional capillary network.

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  Fig. 4. Structural characteristics of LifeLiver. The 70 μ m sized spheroids are encapsulated using calcium alginate beads of 800 μ m size and immobilized in the bioreactor (A, B). The calcium alginate bead acts as a semipermeable barrier protecting the hepatocytes from immunological reaction of the host (C).

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  Fig. 5. Results of preclinical trial of LifeLiver. Decreased blood ammonia level is seen in the bioartificial (BAL) group (A) resulting in increased survival compared to both the control and blank group (B).

Reference

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