ALEX BIOARTIFICIAL LIVER COMBINED WITH AN ALBUMIN DIALYSIS SYSTEM TO TREAT ACUTE LIVER FAILURE IN SWINE

The goal of this study was to evaluate efficacy of a new bioartificial device (ALEX) in an experimental model of acute hepatic failure in pigs combined with a albumin dyalisis system. A Molecular Adsorbent Recycling System (MARS) was connected to a Bioartificial liver (ALEX) filled of 10 billion hepatocytes. A Partial Liver Transplantation was performed. 5 pigs were not treated (G1). 7 were treated by MARS (G2); 7 with ALEX (G3); 7 with MARS and ALEX (C4). The treatments started immediately after PLT. Each treatment was of 6 hours and repeated 3 times a day for 3 days. In G1 100% Pigs died after 24 hours. In G2 1 pig died at day 1; 2 pigs died at day 3; 4 survived at day 3; In G3 2 pigs died after 24 hours, while the remaining pigs survived at day 3; In G4 100% pigs survived at day 3. All the died pigs showed a deep hypoglycemia. Ammonia was 700 m g/dl ± 300 and Total Bilirubin 15 mg/dl ± 6. The urine output was 0 at time 24. An high intracranial pressure was found in G1 and in G2 in the died pigs. In G4 all the parameters considered improved, while in G 2 only the bilirubin and Ammonia and in G3 only the prothrombin time and the intracranial pressure improved. Looking at the hepatic cells in G3 after each treatment 25% of cell viability into the bioreactor dropped. In G4 95% of viability was observed after each treatment. It is clear that by using both system it is possible to give a significant support action, able to all animals to survive to this acute liver failure model. Even the liver cells into the bioreactor, showed a significant improving in function and viability.