Treatment of acute hepatic failure and encephalopathy with extracorporeal ex vivo pig-liver perfusion in the critical care unit

Patients with fulminant hepatic failure have a higher mortality rate after orthotopic liver transplantation than patients with chronic liver disease. Due to the shortage of cadaveric livers for transplantation, the concept of perfusion through a liver outside the body has recently been reintroduced in the clinical setting.

We describe a venovenous perfusion circuit with two Biomed pumps and one oxygenator connected to the patient's venous system via two hemodialysis catheters. The circuit provided adequate flow during ex vivo pig-liver perfusion in a critically ill patient with a stage 5 coma. The procedure lasted 4.5 h and was terminated when the oxygen extraction and bile production decreased, and the total bilirubin level went back up. During the period of ex vivo perfusion the patient moved all four extremities spontaneously within 30 min of perfusion, serum total bilirubin, and the serum ammonia level decreased by 50% and 60% respectively. The patient eventually developed sepsis and the therapy was discontinued.

Conclusion

For patients with acute hepatic failure and encephalopathy associated with cerebral edema in whom cadaveric liver transplantation is not an immediate option, extracorporeal ex vivo pig-liver perfusion is a reasonable alternative in the critical care setting.