Acute liver failure: current management and future prospects

Present status and perspectives of cell-based therapies for liver diseases

In recent years the interest in liver cell therapy has been increasing continuously, since the demand for whole liver transplantations in human beings far outweighs the supply. From the clinical point of view, transplantation of hepatocytes or hepatocyte-like cells may represent an alternative to orthotopic liver transplants in acute liver failure, for the correction of genetic disorders resulting in metabolically deficient states, and for late stage liver disease such as cirrhosis. Although the concept of cell therapy for various diseases of the liver is widely accepted, the practical approach in humans often remains difficult. An international expert panel critically discussed the recent published data on clinical and experimental hepatocyte transplantation and the possible role of stem cells in liver tissue repair. This paper aims to summarise the present status of cell based therapies for liver diseases and to identify areas of future preclinical and clinical research.

Pharmacokinetics and bioavailability study of l-ornithine–l-aspartate in healthy volunteers—A comparative study of two oral formulations

The aim of the evaluation was to establish bioequivalence between two oral 3.0 g sachet forms of L-ornithine-L-aspartate (LOLA). It was designed as randomised, two-way crossover study with a 1-week washout interval. Blood samples were collected throughout a 12 h period after administration of reference and test product to 12 fasting healthy male volunteers. Plasma were analyzed by sensitive, reproducible, accurate and rapid capillary electrophoresis (CE) method with UV detection. Many pharmacokinetic parameters including AUC0-t, AUC0-infinity, Cmax, Tmax, T1/2 and Kel were determined from plasma concentration. First three of them after log-transformation of data were examined for bioequivalence. Based on ANOVA with 90% confidence level no significant difference was found. All of tested parameters were found to be within the bioequivalence acceptance range of 80-125%. Based on these and other statistical tests it was concluded that Hepatil is bioequivalent to Hepa-Merz granulate.

Acute liver failure: a review

Since publication of the first descriptions of acute liver failure (ALF) as a distinct clinical entity in the 1950's, the understanding of the pathophysiologic mechanisms involved and the management options have increased substantially. ALF still represents a major challenge for todays hepatologists, because it can rapidly lead to multiorgan failure and death that may be preventable with appropriate intervention. This article summarizes the basic patho-physiology underlying ALF, compares epidemiologic trends in the United States, the United Kingdom, and the Far East, and reviews prognostic markers and treatment options for ALF.

Successful liver transplantation and delivery in a woman with fulminant hepatic failure occurring during the second trimester of pregnancy

BACKGROUND

Severe liver dysfunction occurring during pregnancy is an unusual but dramatic event that poses special technical and ethical issues because it involves two lives.

METHODS AND RESULTS

We report the case of a 35-year-old woman with cryptogenic fulminant hepatic failure who underwent successful orthotopic liver transplantation at 22 weeks of pregnancy. After a relatively uneventful post-operative course she delivered a normal offspring at the 27th week of gestation. There were no obstetrical complications and neonatal outcome was excellent. After a year of follow-up, the patient is doing well,and the newborn has exhibited normal psychomotor and weight/height development.

CONCLUSION

This case illustrates the challenge of treating fulminant hepatic failure during pregnancy and demonstrates that liver transplantation is a feasible therapeutic option for treatment of patients with this condition, allowing successful completion of pregnancy.