In addition to the conventional conservative treatment of hepatic coma, there are seve-ral methods as temporary liver replacement, such as
1) exchange transfusion,
2) homologous or heterologous cross circulation.
3) hemoperfusion with activated charcoal,
4) extracorporeal vital liver perfusion with pig, baboon or human livers,
5) liver transplantation. (definitive treatment).
Since Eiseman et al. introduced the concept of hepatic assist by ex vivo liver perfusion, many investigator have tried the technique for the treatment of patients in a state of hepatic coma. One can achive better results with baboon livers than with pig livers.
The reasons are as followings,
1) It can maintain much longer (as long as 24 hours)than with pig livers(5-6 hours),
2) As to the immunologic problems, because of smaller antigenic disparity between man and baboon than between man and pig; with baboon liver, it causes neither clinical reactions nor antiserum antibody, whereas with pig livers it O.n.os several antipig serum antibodies, such as hemagglutinins, leukoagglutinin, lymphocytotoxic antibody and precipitating antibody.
3) With baboon liver, it causes much less thrombocytopenia, whereas with pig livers it causes decrease of thrombonytes by 80% after 30 minutes of perfusions. 4) Witb baboon liver, the result is much better than that with pig livers, i.e. the former, reversal of coma or successful rate is 40-50%, in the latter, it is 20-30%.
Ideal indications are endogenous hepatic coma due to acute and potential reversible hepatic necrosis esp. by acute viral hepatitis, and it can be also applied for the treatment of patients with chronic and irreversible liver diseases, such as chronic active hepatitis or far advanced liver cirrhosis. in whom there are no likelihood of sufficient regeneration of liver. for the maintenance of life and to be free from infection till the time of liver trans-plantation.
|