BACKGROUND Liver failure,particularly acute-on-chronic liver failure,is associated with high mortality(50%-90%).The plasma exchange(PE)mode of the artificial liver support system has been shown to improve clinical out...BACKGROUND Liver failure,particularly acute-on-chronic liver failure,is associated with high mortality(50%-90%).The plasma exchange(PE)mode of the artificial liver support system has been shown to improve clinical outcomes,although its efficacy may vary depending on the regenerative capacity of the liver.Alpha-fetoprotein(AFP),an oncofetal glycoprotein,is reactivated during liver regeneration and may serve as a prognostic biomarker.Previous studies have reported significantly higher post-PE AFP levels in survivors than in non-survivors(286.5 ng/mL vs 82.3 ng/mL at day 7).However,the predictive value of baseline AFP stratification and serial AFP kinetics during PE therapy remains unestablished.This study investigated whether serial AFP measurements predict clinical outcomes in liver failure patients receiving PE.AIM To evaluate the predictive value of serial AFP measurements in liver failure patients receiving PE.METHODS This retrospective study included 194 liver failure patients with complete AFP data,excluding those with tumors,bleeding disorders,allergies,or unstable conditions.Patients were stratified by baseline AFP into low-AFP(<100 ng/mL,n=60),medium-AFP(100-200 ng/mL,n=70),and high-AFP(>200 ng/mL,n=64)groups.AFP was measured before PE and on days 1,10,20,and 25.RESULTS Stratification by baseline AFP revealed significant gradients.The high-AFP group required fewer PE sessions than the low-AFP group(2.8±1.0 vs 4.2±1.5)but exhibited greater post-PE AFP elevation(75.1±20.3 ng/mL vs 33.1±10.2 ng/mL;P<0.001).The high-AFP group demonstrated optimal values,including the lowest ammonia,bilirubin,alanine aminotransferase,aspartate aminotransferase,γ-glutamyl transferase,and the highest albumin and prothrombin activity(all post hoc P<0.05 vs low-AFP).The medium-AFP group showed intermediate values except for prothrombin activity(35.2%±8.6%),which was significantly lower than in both other groups(P<0.001).The high-AFP group had a reduced incidence of spontaneous bacterial peritonitis(9.4%vs 25.0%;P=0.003),superior three-month survival(90.6%vs 56.7%;P<0.001),and a higher post-treatment three-month receiver operating characteristic area under the curve(0.8851 vs 0.7051).CONCLUSION AFP dynamics correlate with regenerative capacity and clinical outcomes in liver failure.Serial AFP monitoring may enhance risk stratification and support personalized therapeutic strategies.展开更多
BACKGROUND： Plasma exchange （PE）-centered artificial liver support system reduced the high mortality rate of hepa titis B virus （HBV）-related acute-on-chronic liver failure （ACLF）. But the data were diverse in ...BACKGROUND： Plasma exchange （PE）-centered artificial liver support system reduced the high mortality rate of hepa titis B virus （HBV）-related acute-on-chronic liver failure （ACLF）. But the data were diverse in different medical centers. The present prospective nationwide study was to evaluate the effects of PE on patients with HBV-ACLF at different stages.展开更多
Liver transplantation and blood purification therapy,including plasmapheresis,hemodiafiltration,and bioartificial liver support,are the available treatments for patients with severe hepatic failure.Bioartificial liver...Liver transplantation and blood purification therapy,including plasmapheresis,hemodiafiltration,and bioartificial liver support,are the available treatments for patients with severe hepatic failure.Bioartificial liver support,in which living liver tissue is used to support hepatic function,has been anticipated as an effective treatment for hepatic failure.The two mainstream systems developed for bioartificial liver support are extracorporeal whole liver perfusion(ECLP)and bioreactor systems.Comparing various types of bioartificial liver in view of function,safety,and operability,we concluded that the best efficacy can be provided by the ECLP system.Moreover,in our subsequent experiments comparing ECLP and apheresis therapy,ECLP offers more ammonia metabolism than HD and HF.In addition,ECLP can compensate amino acid imbalance and can secret bile.A controversial point with ECLP is the procedure is labor intensive,resulting in high costs.However,ECLP has the potential to reduce elevated serum ammonia levels of hepatic coma patients in a short duration.When these problems are solved,bioartificial liver support,especially ECLP,can be adopted as an option in ordinary clinical therapy to treat patients with hepatic failure.展开更多
AIM： To establish a method detecting porcine endogenous retrovirus （PERV） in China experimental minipigs and to evaluate the safety of PERV in three individuals treated with bioartificial liver support systems base...AIM： To establish a method detecting porcine endogenous retrovirus （PERV） in China experimental minipigs and to evaluate the safety of PERV in three individuals treated with bioartificial liver support systems based on porcine hepatocytes. METHODS： Porcine hepatocytes were isolated with two-stage perfusion method, then cultured in the bioreactor, which is separated by a semipermeable membrane （0.2μm） from the lumen through which the patients＇ blood plasma was circulated. After posthemoperfusion, patients＇ blood was obtained for screening. Additionally, samples of medium collected from both intraluminal and extraluminal compartments of the laboratory bioreactor and culture supernate in vitro was analyzed. The presence of viral sequences was estimated by polymerase chain reaction （PCR） and reverse transcriptase-polymerase chain reaction （RTPCR）. Finally, the infection of virus in the supernate of common culture was ascertained by exposure to the fetal liver cells. RESULTS： PERV-specific gag sequences were found in the porcine hepatocytes using RT-PCR. and were detected in all samples from the intraluminal, extraluminal samples and culture supernate. However, culture supernatant from primary porcine hepatocytes （cleared of cellular debris） failed to infect human fetal liver cells. Finally, RT-PCR detected no PERV infection was found in the blood samples obtained from three patients at various times post-hemoperfusion. CONCLUSION： The assays used are specific and sensitive, identified by second PCR. PERVs could be released from hepatocytes cultured in bioreactor without the stimulation of mitogen and could not be prevented by the hollow fiber semipermeable membrane, indicating the existence of PERV safety in extracorporeal bioartificial liver support system （EBLSS）.展开更多
AIM: To construct a novel hybrid artificial liver support system (HALSS) and to evaluate its efficacy in patients with severe liver failure.METHODS: Hepatocytes were isolated from suckling pig by the modified Seglen&#...AIM: To construct a novel hybrid artificial liver support system (HALSS) and to evaluate its efficacy in patients with severe liver failure.METHODS: Hepatocytes were isolated from suckling pig by the modified Seglen's method. Isolated hepatocytes were cultured in a spinner flask for 24 h to form spheroids before use and the functions of spheroids were detected. HALSS consisted of a plasma separator, a hemo-adsorba and a bioreactor with hepatocytes spheroids in its extra-fiber space.HALSS was applied to 10 patients with severe liver failure.The general condition and the biochemical indexes of the patients were studied just before and after the treatment.RESULTS: The number of cells per liver was about 2-4× 1010 (mean, 3.1 ± 1.5 × 1010). The cell viabilities were more than 95%. After 24 h of spheroid culture, most hepatocytes formed spheroids. The levels of albumin and urea in the medium of spheroid culture were higher than those in supernatant of petri dish culture (P = 0.0015 and 0.0001, respectively). The capacity of albumin production and urea synthesis remained stable for more than one wk and declined rapidly after two weeks in vitro. In HALSS group, the duration of HALSS treatment was 6-10 h each time. All patients tolerated the treatment well without any fatal adverse reaction. After HALSS treatment, the general condition, psychic state, encephalopathy and hepatic function of the patients were improved. The survival rate of the HALSS group, Plasmapheresis group and control group was 30% (3/10), 20% (2/10) and 0% (0/10), respectively (P = 0.024). Two weeks after treatment, Tbil and ALT decreased and the PTA level elevated in HALSS group and pasmapheresis group (Pvalue: 0.015 vs 0.020, 0.009vs 0.012 and 0.032 vs 0.041, respectively). But there was no significant change of blood albumin concentration before and after treatment in HAlSS group and Plasmapheresis group.CONCLUSION: The HALSS established by us is effective in supporting liver function of patients with severe liver failure.展开更多
BACKGROUND The artificial liver support system(ALSS)is an effective treatment method for liver failure,but it requires deep venous intubation and long-term indwelling catheterization.However,the coagulation mechanism ...BACKGROUND The artificial liver support system(ALSS)is an effective treatment method for liver failure,but it requires deep venous intubation and long-term indwelling catheterization.However,the coagulation mechanism disorder of basic liver failure diseases,and deep venous thrombosis(DVT)often occur.AIM To evaluate the risk factors for DVT following use of an ALSS and establish a risk assessment score.METHODS This study was divided into three stages.In the first stage,the risk factors for DVT were screened and the patient data were collected,including ALSS treatment information;biochemical indices;coagulation and hematology indices;complications;procoagulant use therapy status;and a total of 24 indicators.In the second stage,a risk assessment score for DVT after ALSS treatment was developed.In the third stage,the DVT risk assessment score was validated.RESULTS A total of 232 patients with liver failure treated with ALSS were enrolled in the first stage,including 12 with lower limb DVT.Logistic regression analysis showed that age[odds ratio(OR),1.734;P=0.01],successful catheterization time(OR,1.667;P=0.005),activity status(strict bed rest)(OR,3.049;P=0.005),and D-dimer level(≥500 ng/mL)(OR,5.532;P<0.001)were independent risk factors for DVT.We then established a scoring system for risk factors.In the validation group,a total of 213 patients with liver failure were treated with ALSS,including 14 with lower limb DVT.When the cutoff value of risk assessment was 3,the specificity and sensitivity of the risk assessment score were 88.9%and 85.7%,respectively.CONCLUSION A simple risk assessment scoring system was established for DVT patients with liver failure treated with ALSS and was verified to have good sensitivity and specificity.展开更多
BACKGROUND: Molecular adsorbents recirculating sys- tem (MARS) liver support therapy is the development of albumin dialysis. This study was to assess the successful ap- plication of MARS artificial liver support thera...BACKGROUND: Molecular adsorbents recirculating sys- tem (MARS) liver support therapy is the development of albumin dialysis. This study was to assess the successful ap- plication of MARS artificial liver support therapy as a bridge to re-transplantation in two cases of long anhepatic duration. METHODS: MARS therapy was given after failure plasma- exchange ( PE) treatment, which resulted in circulatory de- rangement and acute renal dysfunction in a 36-year-old male patient. Finally his uncontrolled anhepatic condition led to a successful re-transplantation. In another 48-year- old man who was diagnosed as having primary nonfunction (PNF) during the liver transplantation, 10-hour MARS treatment contributed to smooth bridging of his anhepatic phase. RESULTS: The two anhepatic patients were bridged for 26 and 17 hours respectively to re-transplantation with MARS therapy. CONCLUSION: Our experience proves that MARS artifi- cial liver can be an effective support for long time bridging PNF until re-transplantation is available.展开更多
The severity of alcoholic hepatitis(AH) which may coexist with cirrhosis varies greatly, from asymptomatic forms which are detected in alcoholic patients without any sign of liver disease, except laboratory abnormalit...The severity of alcoholic hepatitis(AH) which may coexist with cirrhosis varies greatly, from asymptomatic forms which are detected in alcoholic patients without any sign of liver disease, except laboratory abnormalities, to severe forms characterised by deep jaundice, ascites, hepatic encephalopathy and low prothrombin index. In hospitalized patients the mortality could be as high as 75%. The elevated number of therapeutic proposals reported for more than forty years reveals the lack of efficacy of a particular modality. Even in the most favorable trials, the survival is already very poor and in some cases related to the development of renal failure or hepatorenal syndrome. There are some motivating reports concerning albumin dialysis as a support treatment in patients with severe AH, either alone or in combination with other pharmacological therapies. The favorable effects of albumin dialysis in patients with severe AH suggest that the procedure used alone or in combination with other therapies may have a role in this clinical condition. This will be particularly relevant to offer an alternative therapy in these patients, thus being a potential bridge to recovery or to be listed for liver transplantation.展开更多
BACKGROUND:The demand for the clinical use of hepa-tocytes is increasing.The aim of this study was to develop a method for procurement of high qualitative pig hepatocytes and to evaluate the state of freshly isolated ...BACKGROUND:The demand for the clinical use of hepa-tocytes is increasing.The aim of this study was to develop a method for procurement of high qualitative pig hepatocytes and to evaluate the state of freshly isolated and cultured hepatocytes.METHODS:The domestic extracorporeal circulating perfu-sion apparatus was used to isolate and harvest swine hepato-cytes by the two-step perfusion method with EDTA and collagenase.The viability,function and morphology of the freshly isolated and cultured cells were evaluated and ob-served by the trypan blue exclusion test,biochemical mea-surements,phase contrast microscopy and transmission electron micrography(TEM).RESULTS:The total yield of isolated hepatocytes reached to 1.5(±0.4)×l010 per liver with a viability of 92(±5)%,and the purity of hepatocytes reached to 98%Immediately after isolation,phase-contrast microscope and TEM showed that undamaged hepatocytes appeared bright,translucent and spherical in shape,with a characteristic well-contrasted border.After 24 hours,the concentrations of alanine aminotransferase(ALT),aspartate aminotrans-ferase(AST),lactate dehydrogenase(LDH),albumin(ALB),creatinine(Cr)and blood urea nitrogen(BUN)in the fluid of culture were declined significantly.CONCLUSION:This method of procuring swine hepato-cytes could get high quality cells with active metabolic function.展开更多
BACKGROUND The increased expression of G3BP1 was positively correlated with the prognosis of liver failure.AIM To investigate the effect of G3BP1 on the prognosis of acute liver failure(ALF)and acute-on-chronic liver ...BACKGROUND The increased expression of G3BP1 was positively correlated with the prognosis of liver failure.AIM To investigate the effect of G3BP1 on the prognosis of acute liver failure(ALF)and acute-on-chronic liver failure(ACLF)after the treatment of artificial liver support system(ALSS).METHODS A total of 244 patients with ALF and ACLF were enrolled in this study.The levels of G3BP1 on admission and at discharge were detected.The validation set of 514 patients was collected to verify the predicted effect of G3BP1 and the viability of prognosis.RESULTS This study was shown that lactate dehydrogenase(LDH),alpha-fetoprotein(AFP)and prothrombin time were closely related to the prognosis of patients.After the ALSS treatment,the patient’amount of decreased G3BP1 index in difference of G3BP1 between the value of discharge and admission(difG3BP1)<0 group had a nearly 10-fold increased risk of progression compared with the amount of increased G3BP1 index.The subgroup analysis showed that the difG3BP1<0 group had a higher risk of progression,regardless of model for end-stage liver disease high-risk or low-risk group.At the same time,compared with the inflam matory marks[tumor necrosis factor-α,interleukin(IL)-1βand IL-18],G3BP1 had higher discrimination and was more stable in the model analysis and validation set.When combined with AFP and LDH,concordance index was respectively 0.84 and 0.8 in training and validation cohorts.CONCLUSION This study indicated that G3BP1 could predict the prognosis of ALF or ACLF patients treated with ALSS.The combination of G3BP1,AFP and LDH could accurately evaluate the disease condition and predict the clinical endpoint of patients.展开更多
This study outlines the essential nursing strategies employed in the care of 10 patients experiencing vascular vagal reflex, managed with artificial liver support systems. It highlights a holistic nursing approach tai...This study outlines the essential nursing strategies employed in the care of 10 patients experiencing vascular vagal reflex, managed with artificial liver support systems. It highlights a holistic nursing approach tailored to the distinct clinical manifestations of these patients. Key interventions included early detection of psychological issues prior to initiating treatment, the implementation of comprehensive health education, meticulous monitoring of vital signs throughout the therapy, prompt emergency interventions when needed, adherence to prescribed medication protocols, and careful post-treatment observations including venous catheter management. Following rigorous treatment and dedicated nursing care, 7 patients demonstrated significant improvement and were subsequently discharged.展开更多
AIM To evaluate the safety and efficacy of the bioartificial liver support system in canines with acute liver failure (ALF). METHODS Nine canines with acute liver failure by acetaminophen induced received TECA Ⅰ...AIM To evaluate the safety and efficacy of the bioartificial liver support system in canines with acute liver failure (ALF). METHODS Nine canines with acute liver failure by acetaminophen induced received TECA Ⅰ bioartificial liver support system (BALSS) from Hong Kong TECA LTD Co. Blood was perfused through a hollow fiber tube containing (1 2)×10 10 the porcine hepatocytes. In contrast, another 10 canines with acute liver failure by Acetaminophen received drugs. Each treatment lasted 6 hours. RESULTS BALSS treatment resulted in beneficial effects for acetaminophen induced ALF canines with survival and with the recovery of the liver functions and tissues, and plasma ammonia decreased from 135 9μmol/L ± 17 5μmol/L to 65 7μmol/L ± 22 0μmol/L , 32 5μmol/L ± 8 8μmol/L , GPT from 97 8U/L ± 8 7U/L to 64 8U/L ± 11 9U/L , 19 0U/L ± 6 3U/L , GOT from 103 0U/L ± 16 7U/L to 75 7U/L ± 19 6U/L , 26 5U/L ± 5 0U/L , and AKP from 158 3U/L ± 12 1U/L to 114 5U/L ± 19 8U/L , 43 8U/L ± 5 6U/L during and after the treatment. In contrast, 10 ALF canines in both the drug and control groups died 1 or 2 days after treatment. CONCLUSION TECA 1 artificial liver support system is safe and efficacious for canines with acute liver failure.展开更多
AIM To evaluate the possibility of usingcultured human hepatocytes as a bridge betweenbioartificial liver and liver transplantation.METHODS In this experiment,the efficacy ofextracorporeal bioartificial liver support ...AIM To evaluate the possibility of usingcultured human hepatocytes as a bridge betweenbioartificial liver and liver transplantation.METHODS In this experiment,the efficacy ofextracorporeal bioartificial liver support system(EBLSS)consisting of spheriodal human livercells and cultured hepatocytes supernatant wasassessed in vivo using galactosamine inducedrabbit model of fulminant hepatic failure.RESULTS There was no difference of survivalbetween the two groups of rabbits,but in thesupported rabbits serum alanineaminotransferase,total bilirubin and creatininewere significantly lower and hepatocyte necrosiswas markedly milder than those in controlanimals.In addition,a good viability of humanliver cells was noted after the experiment.CONCLUSION EBLSS plays a biologic role inmaintaining and compensating the function ofthe liver.展开更多
Background:Multimodal artificial liver support(ALS)has been proven to be effective in a porcine model of acute liver failure.This study aimed to evaluate the curative effect in patients with acute-on-chronic liver fai...Background:Multimodal artificial liver support(ALS)has been proven to be effective in a porcine model of acute liver failure.This study aimed to evaluate the curative effect in patients with acute-on-chronic liver failure(ACLF).Methods:Data from ACLF patients receiving multimodal ALS between January 2014 and August 2019 were collected.Patients were divided into two groups according to the patterns of ALS:a trimodal ALS group(trimodal group)and a bimodal ALS group(bimodal group).A propensity score matching was performed to control for baseline bias between the groups.Survival rates and laboratory parameters were compared after single session and after completion of all the sessions of treatments.Results:A total of 182 patients undergoing multimodal ALS were screened.Propensity score matching generated 47 pairs.The short-term(28/90 days)survival rates were significantly higher in the trimodal group than those in the bimodal group(28-day survival rate:91.5%vs.76.6%,P=0.049;90-day survival rate:91.5%vs.74.5%,P=0.027).The model for end-stage liver disease score was improved both after single session and after completion of all the sessions of treatments.Single session of trimodal ALS significantly reduced bilirubin(P<0.001)and bile acid(P=0.003)levels compared with bimodal ALS.Compared with baseline,gamma-glutamyltransferase(P=0.001)and alkaline phosphatase(P=0.021)levels were significantly decreased after completion of all the sessions of treatments in the trimodal group.However,no significant differences were observed in these two parameters within the bimodal group.Trimodal ALS was associated with increased clearance rates of interleukin-8(P=0.009)and macrophage migration inhibitory factor(P=0.012).Multivariate Cox regression revealed that trimodal ALS was an independent predictor of lower 28-and 90-day mortality(both P<0.05).Conclusions:Trimodal ALS may provide a greater survival benefit for patients with ACLF,likely because of its superior ability to clear toxic substances and suppress inflammation.展开更多
BACKGROUND The treatment of patients with liver cancer after surgery with the artificial liver support system combined with traditional Chinese medicine(TCM)for strengthening the body and removing blood stasis is a ne...BACKGROUND The treatment of patients with liver cancer after surgery with the artificial liver support system combined with traditional Chinese medicine(TCM)for strengthening the body and removing blood stasis is a new idea.AIM To analyze the post-surgical effect of the artificial liver support system with TCM in patients with liver cancer.METHODS Ninety-eight patients with liver cancer who underwent surgical treatment at the Fifth People’s Hospital of Huai’an from January 2023-2024 were selected and divided into two groups(49 patients each)via random lottery method.Both groups underwent surgery.The control group received artificial liver support,and the observation group was additionally treated with TCM for strengthening the body and removing blood stasis.Gastrointestinal recovery,liver function,tumor marker levels,immune function,and safety were compared between both groups.RESULTS There were significant differences in the levels of indicators related to gastrointestinal recovery between the groups(P<0.05).After treatment,the levels of alanine aminotransferase,aspartate aminotransferase,total bilirubin,and gamma-glutamyl transpeptidase in the observation group were lower,whereas the albumin level was higher(P<0.05).After treatment,tumor marker levels in the observation group were relatively lower(P<0.05).After treatment,compared to the control group,the CD4+level in the observation group was higher and the CD8+level was lower(P<0.05).There was no significant difference in the incidence of adverse reactions between both groups(P>0.05).CONCLUSION Combining the artificial liver support system with TCM significantly improves liver and gastrointestinal functions,enhances immune responses,and reduces tumor marker levels with high safety,suggesting that it could be a promising approach for optimizing postoperative care and improving patient outcomes,potentially reducing complications and enhancing quality of life.展开更多
Objective: Through the treatment of liver failure using artificial liver plasma exchange (PE), this study aims to explore the predictive value and clinical significance of alpha-fetoprotein (AFP) levels in the prognos...Objective: Through the treatment of liver failure using artificial liver plasma exchange (PE), this study aims to explore the predictive value and clinical significance of alpha-fetoprotein (AFP) levels in the prognosis of liver failure patients. Methods: A retrospective analysis was conducted on the clinical data of 96 liver failure patients, all of whom underwent artificial liver plasma exchange therapy in addition to standard medical treatment. Based on AFP test values, patients were divided into three groups: low AFP group (AFP < 100 ng/mL, n = 32), medium AFP group (100 ≤ AFP < 200 ng/mL, n = 32), and high AFP group (AFP ≥ 200 ng/mL, n = 32). Serum AFP levels were measured before artificial liver therapy (on the second day of hospitalization), on days 1, 10, and 20 after treatment, and at the final evaluation (before discharge or prior to death) to observe changes. Results: Among the 96 patients, 4 (4.2%) had acute liver failure (ALF), 7 (7.3%) had subacute liver failure (SALF), 57 (59.4%) had acute-on-chronic liver failure (ACLF), and 28 (29.2%) had chronic liver failure (CLF), with an overall survival rate of 82.3% (79/96). Patients in the AFP < 100 ng/mL group had a lower survival rate compared to the other two groups, and survival rates increased with higher AFP levels (P < 0.05). Conclusion: Serum AFP levels are closely related to the efficacy of artificial liver plasma exchange therapy for liver failure, and dynamic monitoring of AFP changes can help assess disease progression.展开更多
BACKGROUND We have innovatively amalgamated membrane blood purification and centrifugal blood cell separation technologies to address the limitations of current artificial liver support(ALS)models,and develop a versat...BACKGROUND We have innovatively amalgamated membrane blood purification and centrifugal blood cell separation technologies to address the limitations of current artificial liver support(ALS)models,and develop a versatile plasma purification system(VPPS)through centrifugal plasma separation.AIM To investigate the influence of VPPS on long-term rehospitalization and mortality rates among patients with acute-on-chronic liver failure(ACLF).METHODS This real-world,prospective study recruited inpatients diagnosed with ACLF from the Second Xiangya Hospital of Central South University between October 2021 and March 2024.Patients were categorized into the VPPS and non-VPPS groups based on the distinct ALS models administered to them.Self-administered questionnaires,clinical records,and self-reported data served as the primary methods for data collection.The laboratory results were evaluated at six distinct time points.All patients were subjected to follow-up assessments for>12 months.Kaplan-Meier survival analyses and Cox proportional hazards models were used to evaluate the risks of hospitalization and mortality during the follow-up period.RESULTS A cohort of 502 patients diagnosed with ACLF was recruited,with 260 assigned to the VPPS group.On comparing baseline characteristics,the VPPS group exhibited a significantly shorter length of stay,higher incidence of spontaneous peritonitis and pulmonary aspergillosis compared to the non-VPPS group(P<0.05).Agehazard ratio(HR=1.142,95%CI:1.01-1.23,P=0.018),peritonitis(HR=2.825,95%CI:1.07-6.382,P=0.026),albumin(HR=0.67,95%CI:0.46-0.942,P=0.023),total bilirubin(HR=1.26,95%CI:1.01-3.25,P=0.021),international normalized ratio(HR=1.97,95%CI:1.21-2.908,P=0.014),and VPPS/non-VPPS(HR=3.24,95%CI:2.152-4.76,P<0.001)were identified as significant independent predictors of mortality in both univariate and multivariate analyses throughout the follow-up period.Kaplan-Meier survival analyses demonstrated significantly higher rehospitalization and mortality rates in the non-VPPS group compared to the VPPS group during follow-up of≥2 years(log-rank test,P<0.001).CONCLUSION These findings suggest that VPPS is safe and has a positive influence on prognostic outcomes in patients with ACLF.展开更多
Acute liver failure(ALF)is a rare but life-threatening condition marked by rapid hepatic dysfunction,coagulopathy and encephalopathy in patients without prior liver disease.Common causes include drug-induced liver inj...Acute liver failure(ALF)is a rare but life-threatening condition marked by rapid hepatic dysfunction,coagulopathy and encephalopathy in patients without prior liver disease.Common causes include drug-induced liver injury,viral hepatitis,and metabolic or autoimmune disorders.This review provides an updated overview of ALF’s etiology,diagnosis,and management.Timely diagnosis and risk stratification using tools like the King’s College Criteria and Model for End-Stage Liver Disease score are critical for guiding care.Early identification of etiology allows targeted treatments,such as N-acetylcysteine for acetaminophen toxicity or antivirals for hepatitis.Supportive care in specialized intensive care units,focused on hemodynamics,cerebral edema prevention,and metabolic stabilization,remains the cornerstone of management.Advances in extracorporeal liver support systems,such as molecular adsorbent recirculating systems and plasma exchange,offer promising bridges to recovery or liver transplantation-the definitive treatment for irreversible liver injury.Expanded donor criteria and improved allocation policies have enhanced transplantation access.Despite progress,ALF carries significant morbidity and mortality.Emerging therapies,including stem cell treatments and immunomodulatory agents,show potential to revolutionize care.This review emphasizes the need for a multidisciplinary approach and continued research to improve outcomes and refine therapeutic strategies.展开更多
Objective: Donors’ quality of life (QOL) and social support were investigated in this study. Method: The SF-36 scale and social support scale were used to survey the quality of life and social support of donors of li...Objective: Donors’ quality of life (QOL) and social support were investigated in this study. Method: The SF-36 scale and social support scale were used to survey the quality of life and social support of donors of live liver transplantation. Result: The PCS (Physical Correlated Score) is 84.78 ± 13.21, the MCS (Mental Correlated Score) is 80.71 ± 14.65, and the total score is 165.49 ± 22.63. The results show the significant difference at GH (General Health) & VT (Vitality) domain regarding the age, P < 0.05;while there’s a significant difference at BP (Body Pain) domain regarding the sex, P < 0.05. The social support score of male & female donors are 37.75 ± 7.50 and 44.00 ± 4.30, and the difference is significant, P < 0.05. The MCS and the social support score are correlated, the correlation factor is 0.483, P < 0.05. Conclusion: There’s no significant difference between the donors and the normal population. The age is the risk factor of QOL, and it should be paid more attention when we select the donor. Excellent social support relates to high quality of life.展开更多
基金Supported by National Natural Science Foundation of China,No.82160106.
文摘BACKGROUND Liver failure,particularly acute-on-chronic liver failure,is associated with high mortality(50%-90%).The plasma exchange(PE)mode of the artificial liver support system has been shown to improve clinical outcomes,although its efficacy may vary depending on the regenerative capacity of the liver.Alpha-fetoprotein(AFP),an oncofetal glycoprotein,is reactivated during liver regeneration and may serve as a prognostic biomarker.Previous studies have reported significantly higher post-PE AFP levels in survivors than in non-survivors(286.5 ng/mL vs 82.3 ng/mL at day 7).However,the predictive value of baseline AFP stratification and serial AFP kinetics during PE therapy remains unestablished.This study investigated whether serial AFP measurements predict clinical outcomes in liver failure patients receiving PE.AIM To evaluate the predictive value of serial AFP measurements in liver failure patients receiving PE.METHODS This retrospective study included 194 liver failure patients with complete AFP data,excluding those with tumors,bleeding disorders,allergies,or unstable conditions.Patients were stratified by baseline AFP into low-AFP(<100 ng/mL,n=60),medium-AFP(100-200 ng/mL,n=70),and high-AFP(>200 ng/mL,n=64)groups.AFP was measured before PE and on days 1,10,20,and 25.RESULTS Stratification by baseline AFP revealed significant gradients.The high-AFP group required fewer PE sessions than the low-AFP group(2.8±1.0 vs 4.2±1.5)but exhibited greater post-PE AFP elevation(75.1±20.3 ng/mL vs 33.1±10.2 ng/mL;P<0.001).The high-AFP group demonstrated optimal values,including the lowest ammonia,bilirubin,alanine aminotransferase,aspartate aminotransferase,γ-glutamyl transferase,and the highest albumin and prothrombin activity(all post hoc P<0.05 vs low-AFP).The medium-AFP group showed intermediate values except for prothrombin activity(35.2%±8.6%),which was significantly lower than in both other groups(P<0.001).The high-AFP group had a reduced incidence of spontaneous bacterial peritonitis(9.4%vs 25.0%;P=0.003),superior three-month survival(90.6%vs 56.7%;P<0.001),and a higher post-treatment three-month receiver operating characteristic area under the curve(0.8851 vs 0.7051).CONCLUSION AFP dynamics correlate with regenerative capacity and clinical outcomes in liver failure.Serial AFP monitoring may enhance risk stratification and support personalized therapeutic strategies.
基金supported by grants from the National Science and Technology Major Project(2012ZX10002004)Scientific Research Fund of Zhejiang Provincial Education Department(Y201328037)the opening foundation of the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases and Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases,First Affiliated Hospital,Zhejiang University School of Medicine(2015KF04)
文摘BACKGROUND： Plasma exchange （PE）-centered artificial liver support system reduced the high mortality rate of hepa titis B virus （HBV）-related acute-on-chronic liver failure （ACLF）. But the data were diverse in different medical centers. The present prospective nationwide study was to evaluate the effects of PE on patients with HBV-ACLF at different stages.
文摘Liver transplantation and blood purification therapy,including plasmapheresis,hemodiafiltration,and bioartificial liver support,are the available treatments for patients with severe hepatic failure.Bioartificial liver support,in which living liver tissue is used to support hepatic function,has been anticipated as an effective treatment for hepatic failure.The two mainstream systems developed for bioartificial liver support are extracorporeal whole liver perfusion(ECLP)and bioreactor systems.Comparing various types of bioartificial liver in view of function,safety,and operability,we concluded that the best efficacy can be provided by the ECLP system.Moreover,in our subsequent experiments comparing ECLP and apheresis therapy,ECLP offers more ammonia metabolism than HD and HF.In addition,ECLP can compensate amino acid imbalance and can secret bile.A controversial point with ECLP is the procedure is labor intensive,resulting in high costs.However,ECLP has the potential to reduce elevated serum ammonia levels of hepatic coma patients in a short duration.When these problems are solved,bioartificial liver support,especially ECLP,can be adopted as an option in ordinary clinical therapy to treat patients with hepatic failure.
基金Supported by the Natural Scientific Foundation of China No.30027001
文摘AIM： To establish a method detecting porcine endogenous retrovirus （PERV） in China experimental minipigs and to evaluate the safety of PERV in three individuals treated with bioartificial liver support systems based on porcine hepatocytes. METHODS： Porcine hepatocytes were isolated with two-stage perfusion method, then cultured in the bioreactor, which is separated by a semipermeable membrane （0.2μm） from the lumen through which the patients＇ blood plasma was circulated. After posthemoperfusion, patients＇ blood was obtained for screening. Additionally, samples of medium collected from both intraluminal and extraluminal compartments of the laboratory bioreactor and culture supernate in vitro was analyzed. The presence of viral sequences was estimated by polymerase chain reaction （PCR） and reverse transcriptase-polymerase chain reaction （RTPCR）. Finally, the infection of virus in the supernate of common culture was ascertained by exposure to the fetal liver cells. RESULTS： PERV-specific gag sequences were found in the porcine hepatocytes using RT-PCR. and were detected in all samples from the intraluminal, extraluminal samples and culture supernate. However, culture supernatant from primary porcine hepatocytes （cleared of cellular debris） failed to infect human fetal liver cells. Finally, RT-PCR detected no PERV infection was found in the blood samples obtained from three patients at various times post-hemoperfusion. CONCLUSION： The assays used are specific and sensitive, identified by second PCR. PERVs could be released from hepatocytes cultured in bioreactor without the stimulation of mitogen and could not be prevented by the hollow fiber semipermeable membrane, indicating the existence of PERV safety in extracorporeal bioartificial liver support system （EBLSS）.
基金Supported by Health Office of Jangsu Province Science Research Foundation, No. WK2002 (for important subject) and H200145 (for natural science)
文摘AIM: To construct a novel hybrid artificial liver support system (HALSS) and to evaluate its efficacy in patients with severe liver failure.METHODS: Hepatocytes were isolated from suckling pig by the modified Seglen's method. Isolated hepatocytes were cultured in a spinner flask for 24 h to form spheroids before use and the functions of spheroids were detected. HALSS consisted of a plasma separator, a hemo-adsorba and a bioreactor with hepatocytes spheroids in its extra-fiber space.HALSS was applied to 10 patients with severe liver failure.The general condition and the biochemical indexes of the patients were studied just before and after the treatment.RESULTS: The number of cells per liver was about 2-4× 1010 (mean, 3.1 ± 1.5 × 1010). The cell viabilities were more than 95%. After 24 h of spheroid culture, most hepatocytes formed spheroids. The levels of albumin and urea in the medium of spheroid culture were higher than those in supernatant of petri dish culture (P = 0.0015 and 0.0001, respectively). The capacity of albumin production and urea synthesis remained stable for more than one wk and declined rapidly after two weeks in vitro. In HALSS group, the duration of HALSS treatment was 6-10 h each time. All patients tolerated the treatment well without any fatal adverse reaction. After HALSS treatment, the general condition, psychic state, encephalopathy and hepatic function of the patients were improved. The survival rate of the HALSS group, Plasmapheresis group and control group was 30% (3/10), 20% (2/10) and 0% (0/10), respectively (P = 0.024). Two weeks after treatment, Tbil and ALT decreased and the PTA level elevated in HALSS group and pasmapheresis group (Pvalue: 0.015 vs 0.020, 0.009vs 0.012 and 0.032 vs 0.041, respectively). But there was no significant change of blood albumin concentration before and after treatment in HAlSS group and Plasmapheresis group.CONCLUSION: The HALSS established by us is effective in supporting liver function of patients with severe liver failure.
基金Supported by China Public Health Alliance,No.GWLM202031.
文摘BACKGROUND The artificial liver support system(ALSS)is an effective treatment method for liver failure,but it requires deep venous intubation and long-term indwelling catheterization.However,the coagulation mechanism disorder of basic liver failure diseases,and deep venous thrombosis(DVT)often occur.AIM To evaluate the risk factors for DVT following use of an ALSS and establish a risk assessment score.METHODS This study was divided into three stages.In the first stage,the risk factors for DVT were screened and the patient data were collected,including ALSS treatment information;biochemical indices;coagulation and hematology indices;complications;procoagulant use therapy status;and a total of 24 indicators.In the second stage,a risk assessment score for DVT after ALSS treatment was developed.In the third stage,the DVT risk assessment score was validated.RESULTS A total of 232 patients with liver failure treated with ALSS were enrolled in the first stage,including 12 with lower limb DVT.Logistic regression analysis showed that age[odds ratio(OR),1.734;P=0.01],successful catheterization time(OR,1.667;P=0.005),activity status(strict bed rest)(OR,3.049;P=0.005),and D-dimer level(≥500 ng/mL)(OR,5.532;P<0.001)were independent risk factors for DVT.We then established a scoring system for risk factors.In the validation group,a total of 213 patients with liver failure were treated with ALSS,including 14 with lower limb DVT.When the cutoff value of risk assessment was 3,the specificity and sensitivity of the risk assessment score were 88.9%and 85.7%,respectively.CONCLUSION A simple risk assessment scoring system was established for DVT patients with liver failure treated with ALSS and was verified to have good sensitivity and specificity.
文摘BACKGROUND: Molecular adsorbents recirculating sys- tem (MARS) liver support therapy is the development of albumin dialysis. This study was to assess the successful ap- plication of MARS artificial liver support therapy as a bridge to re-transplantation in two cases of long anhepatic duration. METHODS: MARS therapy was given after failure plasma- exchange ( PE) treatment, which resulted in circulatory de- rangement and acute renal dysfunction in a 36-year-old male patient. Finally his uncontrolled anhepatic condition led to a successful re-transplantation. In another 48-year- old man who was diagnosed as having primary nonfunction (PNF) during the liver transplantation, 10-hour MARS treatment contributed to smooth bridging of his anhepatic phase. RESULTS: The two anhepatic patients were bridged for 26 and 17 hours respectively to re-transplantation with MARS therapy. CONCLUSION: Our experience proves that MARS artifi- cial liver can be an effective support for long time bridging PNF until re-transplantation is available.
文摘The severity of alcoholic hepatitis(AH) which may coexist with cirrhosis varies greatly, from asymptomatic forms which are detected in alcoholic patients without any sign of liver disease, except laboratory abnormalities, to severe forms characterised by deep jaundice, ascites, hepatic encephalopathy and low prothrombin index. In hospitalized patients the mortality could be as high as 75%. The elevated number of therapeutic proposals reported for more than forty years reveals the lack of efficacy of a particular modality. Even in the most favorable trials, the survival is already very poor and in some cases related to the development of renal failure or hepatorenal syndrome. There are some motivating reports concerning albumin dialysis as a support treatment in patients with severe AH, either alone or in combination with other pharmacological therapies. The favorable effects of albumin dialysis in patients with severe AH suggest that the procedure used alone or in combination with other therapies may have a role in this clinical condition. This will be particularly relevant to offer an alternative therapy in these patients, thus being a potential bridge to recovery or to be listed for liver transplantation.
基金This study was supported by grants from the NaturalScience Foundation of China(No.30170255)Zhejiang HealthScience Foundation,Zhejiang,China(No.1999ZD009,2004B064)High-Tech Research and Development(863)Programme of China(No.2003AA205150).
文摘BACKGROUND:The demand for the clinical use of hepa-tocytes is increasing.The aim of this study was to develop a method for procurement of high qualitative pig hepatocytes and to evaluate the state of freshly isolated and cultured hepatocytes.METHODS:The domestic extracorporeal circulating perfu-sion apparatus was used to isolate and harvest swine hepato-cytes by the two-step perfusion method with EDTA and collagenase.The viability,function and morphology of the freshly isolated and cultured cells were evaluated and ob-served by the trypan blue exclusion test,biochemical mea-surements,phase contrast microscopy and transmission electron micrography(TEM).RESULTS:The total yield of isolated hepatocytes reached to 1.5(±0.4)×l010 per liver with a viability of 92(±5)%,and the purity of hepatocytes reached to 98%Immediately after isolation,phase-contrast microscope and TEM showed that undamaged hepatocytes appeared bright,translucent and spherical in shape,with a characteristic well-contrasted border.After 24 hours,the concentrations of alanine aminotransferase(ALT),aspartate aminotrans-ferase(AST),lactate dehydrogenase(LDH),albumin(ALB),creatinine(Cr)and blood urea nitrogen(BUN)in the fluid of culture were declined significantly.CONCLUSION:This method of procuring swine hepato-cytes could get high quality cells with active metabolic function.
文摘BACKGROUND The increased expression of G3BP1 was positively correlated with the prognosis of liver failure.AIM To investigate the effect of G3BP1 on the prognosis of acute liver failure(ALF)and acute-on-chronic liver failure(ACLF)after the treatment of artificial liver support system(ALSS).METHODS A total of 244 patients with ALF and ACLF were enrolled in this study.The levels of G3BP1 on admission and at discharge were detected.The validation set of 514 patients was collected to verify the predicted effect of G3BP1 and the viability of prognosis.RESULTS This study was shown that lactate dehydrogenase(LDH),alpha-fetoprotein(AFP)and prothrombin time were closely related to the prognosis of patients.After the ALSS treatment,the patient’amount of decreased G3BP1 index in difference of G3BP1 between the value of discharge and admission(difG3BP1)<0 group had a nearly 10-fold increased risk of progression compared with the amount of increased G3BP1 index.The subgroup analysis showed that the difG3BP1<0 group had a higher risk of progression,regardless of model for end-stage liver disease high-risk or low-risk group.At the same time,compared with the inflam matory marks[tumor necrosis factor-α,interleukin(IL)-1βand IL-18],G3BP1 had higher discrimination and was more stable in the model analysis and validation set.When combined with AFP and LDH,concordance index was respectively 0.84 and 0.8 in training and validation cohorts.CONCLUSION This study indicated that G3BP1 could predict the prognosis of ALF or ACLF patients treated with ALSS.The combination of G3BP1,AFP and LDH could accurately evaluate the disease condition and predict the clinical endpoint of patients.
文摘This study outlines the essential nursing strategies employed in the care of 10 patients experiencing vascular vagal reflex, managed with artificial liver support systems. It highlights a holistic nursing approach tailored to the distinct clinical manifestations of these patients. Key interventions included early detection of psychological issues prior to initiating treatment, the implementation of comprehensive health education, meticulous monitoring of vital signs throughout the therapy, prompt emergency interventions when needed, adherence to prescribed medication protocols, and careful post-treatment observations including venous catheter management. Following rigorous treatment and dedicated nursing care, 7 patients demonstrated significant improvement and were subsequently discharged.
文摘AIM To evaluate the safety and efficacy of the bioartificial liver support system in canines with acute liver failure (ALF). METHODS Nine canines with acute liver failure by acetaminophen induced received TECA Ⅰ bioartificial liver support system (BALSS) from Hong Kong TECA LTD Co. Blood was perfused through a hollow fiber tube containing (1 2)×10 10 the porcine hepatocytes. In contrast, another 10 canines with acute liver failure by Acetaminophen received drugs. Each treatment lasted 6 hours. RESULTS BALSS treatment resulted in beneficial effects for acetaminophen induced ALF canines with survival and with the recovery of the liver functions and tissues, and plasma ammonia decreased from 135 9μmol/L ± 17 5μmol/L to 65 7μmol/L ± 22 0μmol/L , 32 5μmol/L ± 8 8μmol/L , GPT from 97 8U/L ± 8 7U/L to 64 8U/L ± 11 9U/L , 19 0U/L ± 6 3U/L , GOT from 103 0U/L ± 16 7U/L to 75 7U/L ± 19 6U/L , 26 5U/L ± 5 0U/L , and AKP from 158 3U/L ± 12 1U/L to 114 5U/L ± 19 8U/L , 43 8U/L ± 5 6U/L during and after the treatment. In contrast, 10 ALF canines in both the drug and control groups died 1 or 2 days after treatment. CONCLUSION TECA 1 artificial liver support system is safe and efficacious for canines with acute liver failure.
基金the national key project fund of the"9th Five Year Plan",No.96-920-12-02
文摘AIM To evaluate the possibility of usingcultured human hepatocytes as a bridge betweenbioartificial liver and liver transplantation.METHODS In this experiment,the efficacy ofextracorporeal bioartificial liver support system(EBLSS)consisting of spheriodal human livercells and cultured hepatocytes supernatant wasassessed in vivo using galactosamine inducedrabbit model of fulminant hepatic failure.RESULTS There was no difference of survivalbetween the two groups of rabbits,but in thesupported rabbits serum alanineaminotransferase,total bilirubin and creatininewere significantly lower and hepatocyte necrosiswas markedly milder than those in controlanimals.In addition,a good viability of humanliver cells was noted after the experiment.CONCLUSION EBLSS plays a biologic role inmaintaining and compensating the function ofthe liver.
基金supported by grants from the National Sci-ence and Technology Major Project of China(2017ZX10203201)the National Key Research and Development Program of China(2023YFC2308802)。
文摘Background:Multimodal artificial liver support(ALS)has been proven to be effective in a porcine model of acute liver failure.This study aimed to evaluate the curative effect in patients with acute-on-chronic liver failure(ACLF).Methods:Data from ACLF patients receiving multimodal ALS between January 2014 and August 2019 were collected.Patients were divided into two groups according to the patterns of ALS:a trimodal ALS group(trimodal group)and a bimodal ALS group(bimodal group).A propensity score matching was performed to control for baseline bias between the groups.Survival rates and laboratory parameters were compared after single session and after completion of all the sessions of treatments.Results:A total of 182 patients undergoing multimodal ALS were screened.Propensity score matching generated 47 pairs.The short-term(28/90 days)survival rates were significantly higher in the trimodal group than those in the bimodal group(28-day survival rate:91.5%vs.76.6%,P=0.049;90-day survival rate:91.5%vs.74.5%,P=0.027).The model for end-stage liver disease score was improved both after single session and after completion of all the sessions of treatments.Single session of trimodal ALS significantly reduced bilirubin(P<0.001)and bile acid(P=0.003)levels compared with bimodal ALS.Compared with baseline,gamma-glutamyltransferase(P=0.001)and alkaline phosphatase(P=0.021)levels were significantly decreased after completion of all the sessions of treatments in the trimodal group.However,no significant differences were observed in these two parameters within the bimodal group.Trimodal ALS was associated with increased clearance rates of interleukin-8(P=0.009)and macrophage migration inhibitory factor(P=0.012).Multivariate Cox regression revealed that trimodal ALS was an independent predictor of lower 28-and 90-day mortality(both P<0.05).Conclusions:Trimodal ALS may provide a greater survival benefit for patients with ACLF,likely because of its superior ability to clear toxic substances and suppress inflammation.
文摘BACKGROUND The treatment of patients with liver cancer after surgery with the artificial liver support system combined with traditional Chinese medicine(TCM)for strengthening the body and removing blood stasis is a new idea.AIM To analyze the post-surgical effect of the artificial liver support system with TCM in patients with liver cancer.METHODS Ninety-eight patients with liver cancer who underwent surgical treatment at the Fifth People’s Hospital of Huai’an from January 2023-2024 were selected and divided into two groups(49 patients each)via random lottery method.Both groups underwent surgery.The control group received artificial liver support,and the observation group was additionally treated with TCM for strengthening the body and removing blood stasis.Gastrointestinal recovery,liver function,tumor marker levels,immune function,and safety were compared between both groups.RESULTS There were significant differences in the levels of indicators related to gastrointestinal recovery between the groups(P<0.05).After treatment,the levels of alanine aminotransferase,aspartate aminotransferase,total bilirubin,and gamma-glutamyl transpeptidase in the observation group were lower,whereas the albumin level was higher(P<0.05).After treatment,tumor marker levels in the observation group were relatively lower(P<0.05).After treatment,compared to the control group,the CD4+level in the observation group was higher and the CD8+level was lower(P<0.05).There was no significant difference in the incidence of adverse reactions between both groups(P>0.05).CONCLUSION Combining the artificial liver support system with TCM significantly improves liver and gastrointestinal functions,enhances immune responses,and reduces tumor marker levels with high safety,suggesting that it could be a promising approach for optimizing postoperative care and improving patient outcomes,potentially reducing complications and enhancing quality of life.
文摘Objective: Through the treatment of liver failure using artificial liver plasma exchange (PE), this study aims to explore the predictive value and clinical significance of alpha-fetoprotein (AFP) levels in the prognosis of liver failure patients. Methods: A retrospective analysis was conducted on the clinical data of 96 liver failure patients, all of whom underwent artificial liver plasma exchange therapy in addition to standard medical treatment. Based on AFP test values, patients were divided into three groups: low AFP group (AFP < 100 ng/mL, n = 32), medium AFP group (100 ≤ AFP < 200 ng/mL, n = 32), and high AFP group (AFP ≥ 200 ng/mL, n = 32). Serum AFP levels were measured before artificial liver therapy (on the second day of hospitalization), on days 1, 10, and 20 after treatment, and at the final evaluation (before discharge or prior to death) to observe changes. Results: Among the 96 patients, 4 (4.2%) had acute liver failure (ALF), 7 (7.3%) had subacute liver failure (SALF), 57 (59.4%) had acute-on-chronic liver failure (ACLF), and 28 (29.2%) had chronic liver failure (CLF), with an overall survival rate of 82.3% (79/96). Patients in the AFP < 100 ng/mL group had a lower survival rate compared to the other two groups, and survival rates increased with higher AFP levels (P < 0.05). Conclusion: Serum AFP levels are closely related to the efficacy of artificial liver plasma exchange therapy for liver failure, and dynamic monitoring of AFP changes can help assess disease progression.
基金Supported by Natural Science Foundation of Hunan Province,China,No.2022JJ30842 and No.2024JJ6560Clinical Medical Research Center for Viral Hepatitis of Hunan Province,No.2023SK4009Beijing iGandan Foundation,No.RGGJJ-2021-017 and No.iGandanF-1082022-RGG023.
文摘BACKGROUND We have innovatively amalgamated membrane blood purification and centrifugal blood cell separation technologies to address the limitations of current artificial liver support(ALS)models,and develop a versatile plasma purification system(VPPS)through centrifugal plasma separation.AIM To investigate the influence of VPPS on long-term rehospitalization and mortality rates among patients with acute-on-chronic liver failure(ACLF).METHODS This real-world,prospective study recruited inpatients diagnosed with ACLF from the Second Xiangya Hospital of Central South University between October 2021 and March 2024.Patients were categorized into the VPPS and non-VPPS groups based on the distinct ALS models administered to them.Self-administered questionnaires,clinical records,and self-reported data served as the primary methods for data collection.The laboratory results were evaluated at six distinct time points.All patients were subjected to follow-up assessments for>12 months.Kaplan-Meier survival analyses and Cox proportional hazards models were used to evaluate the risks of hospitalization and mortality during the follow-up period.RESULTS A cohort of 502 patients diagnosed with ACLF was recruited,with 260 assigned to the VPPS group.On comparing baseline characteristics,the VPPS group exhibited a significantly shorter length of stay,higher incidence of spontaneous peritonitis and pulmonary aspergillosis compared to the non-VPPS group(P<0.05).Agehazard ratio(HR=1.142,95%CI:1.01-1.23,P=0.018),peritonitis(HR=2.825,95%CI:1.07-6.382,P=0.026),albumin(HR=0.67,95%CI:0.46-0.942,P=0.023),total bilirubin(HR=1.26,95%CI:1.01-3.25,P=0.021),international normalized ratio(HR=1.97,95%CI:1.21-2.908,P=0.014),and VPPS/non-VPPS(HR=3.24,95%CI:2.152-4.76,P<0.001)were identified as significant independent predictors of mortality in both univariate and multivariate analyses throughout the follow-up period.Kaplan-Meier survival analyses demonstrated significantly higher rehospitalization and mortality rates in the non-VPPS group compared to the VPPS group during follow-up of≥2 years(log-rank test,P<0.001).CONCLUSION These findings suggest that VPPS is safe and has a positive influence on prognostic outcomes in patients with ACLF.
文摘Acute liver failure(ALF)is a rare but life-threatening condition marked by rapid hepatic dysfunction,coagulopathy and encephalopathy in patients without prior liver disease.Common causes include drug-induced liver injury,viral hepatitis,and metabolic or autoimmune disorders.This review provides an updated overview of ALF’s etiology,diagnosis,and management.Timely diagnosis and risk stratification using tools like the King’s College Criteria and Model for End-Stage Liver Disease score are critical for guiding care.Early identification of etiology allows targeted treatments,such as N-acetylcysteine for acetaminophen toxicity or antivirals for hepatitis.Supportive care in specialized intensive care units,focused on hemodynamics,cerebral edema prevention,and metabolic stabilization,remains the cornerstone of management.Advances in extracorporeal liver support systems,such as molecular adsorbent recirculating systems and plasma exchange,offer promising bridges to recovery or liver transplantation-the definitive treatment for irreversible liver injury.Expanded donor criteria and improved allocation policies have enhanced transplantation access.Despite progress,ALF carries significant morbidity and mortality.Emerging therapies,including stem cell treatments and immunomodulatory agents,show potential to revolutionize care.This review emphasizes the need for a multidisciplinary approach and continued research to improve outcomes and refine therapeutic strategies.
文摘Objective: Donors’ quality of life (QOL) and social support were investigated in this study. Method: The SF-36 scale and social support scale were used to survey the quality of life and social support of donors of live liver transplantation. Result: The PCS (Physical Correlated Score) is 84.78 ± 13.21, the MCS (Mental Correlated Score) is 80.71 ± 14.65, and the total score is 165.49 ± 22.63. The results show the significant difference at GH (General Health) & VT (Vitality) domain regarding the age, P < 0.05;while there’s a significant difference at BP (Body Pain) domain regarding the sex, P < 0.05. The social support score of male & female donors are 37.75 ± 7.50 and 44.00 ± 4.30, and the difference is significant, P < 0.05. The MCS and the social support score are correlated, the correlation factor is 0.483, P < 0.05. Conclusion: There’s no significant difference between the donors and the normal population. The age is the risk factor of QOL, and it should be paid more attention when we select the donor. Excellent social support relates to high quality of life.
