Studies on acute hepatic insufficiency

Acute hepatic failure (AHF) is one of the most dramatic situations that a clinical physician can encounter. It is also one of the most frustating since death is the result in a large majority of the cases, despite all efforts of the medical and nursing staffs. Although a wide variety of experimental modalities has been devised to treat the syndrome, none has proven to be effective (1,2) and 80 to 90% of those with stage IV disease die (3,4). This prognosis is in marked contrast to that for renal failure, that has undergone a steady improvement in survival statistics in the past decades - largely as a result of rapidly improving artificial kidney devices (5,6). The continuing bleak prognosis for the patient with fulminant hepatic failure has stimulated investigation into the feasibility of developing some sort of artificial device which would take over the essential life-preserving functions of the liver. The basic therapeutic approach to AHF must be intensive care monitoring, treatment of complications, synthetic replacement of certain functions of the liver and detoxification, i.e. the removal of toxic substances which accumulate in fulminant hepatic failure (7). The rationale for detoxification is based on the observation that the accumulation of 'toxins' is related to the development of hepatic encephalopathy and cerebral edema (8), which influence survival (9).