ASAIO GOLD
The 25 Landmark ‘Milestone’ Papers
Published by ASAIO
1955-2003
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Your Commentary --- Milestone Papers to Add
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Artificial
Liver and Apheresis
1.
Nose Y, Mikami J,
Commentary: There are some clinical problems that are so
daunting that simple approaches are unlikely to work, but nonetheless these are
tried anyway. Acute liver failure was treated by hemodialysis
as early as 1956 but results indicated no positive effects and the need for a
more chemically selective approach was apparent (see Transactions ASAIO, Volume
1, 1955). In this paper, Nose and coworkers describe an elegantly simple
approach to providing liver function through an extracorporeal blood treatment
device. The basic idea was to use cellophane membranes to separate blood from a
10 liter tank of “metabolic fluid” containing enzymes, vitamins, amino acids
and importantly, metabolically active pieces of liver from a dog. In vitro
tests demonstrated anaerobic and aerobic metabolism of liver was maintained in
slices, homogenate, freeze-dried slices, and freeze-dried granules (freeze
dried tissues allowed practical assembly of a device in the clinical area). The
beauty of this approach is that while the metabolic products from the blood and
liver pieces can transfer back and forth across the membranes, while proteins,
enzymes and immunologically active components stay
only on the dialysate side. Typical of the
determination of Dr. Nose and coworkers, this first publication also included
animal testing of the device. The survival extension after Eck-Fistula by their
device rivals that obtained today with much more sophisticated bioartificial liver devices using cultured hepatocytes. Dr. Nose also presented testing of the device
in four patients with liver failure, and outcome of these patients was
generally positive. After a huge effort in artificial liver support devices of
the last 10 years, we are at a point of having proven benefit by treatment with
bioartificial and artificial (sorbent)
devices. However, papers like this make me wonder, did we make it all too
complicated? -- Stephen R. Ash, MD, FACP
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