In vivo efficacy of a bioartificial liver in improving spontaneous recovery from fulminant hepatic failure: a controlled study in pigs.

Background. Bioartificial liver may be useful as a bridge to liver transplantation but there are no data of its efficacy in successfully bridging to spontaneous recovery in fulminant hepatic failure. The aim of our study was to evaluate the efficacy of a bioartificial liver in increasing the spontaneous recovery of pigs with hepatic failure. Methods. The bioartificial liver consisted in a semipermeable dialyzer with 0.6×10 9 cryopreserved allogenic hepatocytes. Hepatic failure was induced by portacaval shunt plus 70% hepatectomy and 1 hour occlusion of the hepatic artery. Forty-one pigs were distributed 24 hr after liver failure induction to a group treated with the bioartificial liver (4 hr daily) until recovery or death (n=16), or to a control group (n=25). Intracranial pressure was monitored in 18 additional pigs, before and 4 hr after treatment with the bioartificial liver with (n=12) or without hepatocytes (n=6). Results. Fifteen days after induction of hepatic failure, 44% of the treated animals had survived and recovered from liver failure versus 22% controls (P=0.030). Intracranial pressure decreased from 13.13±5.1 to 7.19±2.06 mmHg (P=0.02) in treated animals, and remained unchanged in sham-treated animals (14.08±1.92 to 12.54±3.82, ns). Conclusions. Bioartificial liver increases survival and allows spontaneous recovery in pigs with fulminant hepatic failure.