A. Pascher
Temporary Liver Replacement with Xenogene and Allogene Extra-Corporal Liver Perfusion

Currently, only very few prospective, controlled, and randomized trials for liver replacement methods during hepatic coma are available. A retrospective analysis of experiences with exogene and allogene extra-corporal liver perfusion worldwide was carried out to create a basis for comparison of different therapeutic methods. This was achieved by means of researching distinguished online databases for literature published between 1964 and 2000. The complete datasets of 198 patients were subject to multivariate analysis using General Linear Method (GLM).
The long-time survival rate of 26% did not exceed survival rates published in data of patients in standard intensiv care. Positive prognostic markers identified were: ages 40 and less (p<0,029), hepatitis B in etiology (p<0,05), and use of baboon or human liver.
ECLP was successful as bridging therapy for liver transplantation in 12 of 14 cases.
Xenogene ECLP useing porcine livers resulted in survival rates similar to a conventional intensive therapy. As of yet, an additive effect of transgene expression of human complementary factors has not shown. ECLP using human livers refused for transplantation could represent an effective and feasible way for temporary liver replacement, but has to face competition from techniques such as bioartificial liver supporting systems. Bridging therapy with ECLP until liver transplantation evidently yields success rates comparable to those of bioreactor-systems.

Key words: extracorporal liverperfusion, acute liver failure, xenotransplantation

Dr. Andreas Pascher
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie
Charité, Campus Virchow-Klinikum
Humboldt Universität zu Berlin
Augustenburgerplatz 1
D-13353 Berlin
E-mail: andreas.pascher@charite.de