Postoperative
liver failure remains a major cause of morbidity and mortality after extensive
hepatectomies. This study aims to evaluate the effectiveness of a hepatocyte
bioreactor in the treatment of experimental post-
hepatectomy liver failure. Our experimental model included a combination of a side-to-side
portacaval shunt, occlusion of the hepatoduodenal ligament for 150 min, 70%
hepatectomy, and reperfusion. Following the development of
liver failure, 12 pigs were randomized into a control group (n = 6) and a treatment group (n = 6). Both groups underwent extracorporeal perfusion through a plasma separation device, a
membrane oxygenator, and two parallel
bioreactors. In the latter group, the
bioreactors were loaded with 10 billion fresh hepatocytes, isolated from a donor pig. Following hepatocyte treatment, all animals were maintained for 24 h under
mechanical ventilation, with intravenous fluid and
glucose supplementation. Hemodynamic parameters, intracranial pressure, and biochemical parameters were measured. Liver biopsies were obtained during the 24-h autopsy. The extracorporeal circuit was well-tolerated hemodynamically. Treated animals had lower intracranial pressure compared with controls (at 24 h, 15 ± 3.1 vs. 22 ± 3.5 mm Hg, P = 0.006). Plasma
ammonia in treated animals was lower compared with controls at 12 h (100 ± 29 vs. 244 ± 131 µmol, P = 0.026). Liver histological study showed decreased
necrosis and increased regeneration activity in treated animals compared with controls. Treatment through an extracorporeal hepatocyte
bioreactor attenuates
brain edema and improves histological and functional parameters of the liver remnant of pigs with posthepatectomy
liver failure.