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Organ transplantation
Published in Harold Ellis, Sala Abdalla, A History of Surgery, 2018
The kidney is the obvious organ for transplantation. It is bilateral, so that, in addition to using a cadaver organ, close relative living donors can volunteer a kidney. In addition, thanks to effective dialysis, the recipient can have his or her general condition improved remarkably and can be maintained for months or years in reasonable health until a suitable graft becomes available. If a kidney graft should fail, the patient can be maintained on dialysis and a subsequent re-grafting can be performed. With other organs, failure can only be rescued by an emergency removal of the donor organ and a re-graft. Other organs present the problems of being single (apart from the lungs) and, to date, long-term support machines have not proved effective in spite of millions of pounds having been spent on experimental liver dialysis and on the development of implantable or extracorporeal heart assist machines.
Development of liposome as a novel adsorbent for artificial liver support system in liver failure
Published in Journal of Liposome Research, 2020
Yue Shen, Yifeng Wang, Yuanyuan Shi, Huajun Tian, Qiuyu Zhu, Feng Ding
Liposomes of low toxicity and decent biocompatibility have long been customized to encapsulate as nanocarriers to specifically deliver diverse bioactive agents for the detection and treatment of a variety of diseases (Hossen 2019). Recently, liposomes have revealed their promising potency in blood cleansing interventions. Forster et al. (2014) developed liposomes with different pH transgradients and showed that liposome-supported peritoneal dialysis was able to improve the extraction of endogenous ammonia and certain drug molecules. Pratsinis et al. (2017) explored the enzymatic liposome-added peritoneal dialysis to accelerate ethanol intoxication in rat models. The addition of liposomes to the dialysate can also significantly improve the removal of protein-bound solutes in uremic rats (Shi et al. 2018). However, the potential of liposome-supported dialysis (LD) in the detoxification of liver failure-related, cholestatic toxins has not been discovered. Bilirubin and bile acids, the typical protein-bound and liver failure-related solutes, have been associated with cytotoxicity and neurotoxicity in mammals (Goncharova et al. 2013), and the increased level of total bilirubin is the independent risk factor for mortality in patients with hepatic encephalopathy (Cordoba et al. 2014). The reversal of the abnormity of these parameters by liver dialysis therapy will give more time for patients with liver failure who are in the waiting list of liver transplantation or for the recovery of liver function.
Advances in the treatment of severe alcoholic hepatitis
Published in Current Medical Research and Opinion, 2019
Wenjun Wang, Ying Xu, Chang Jiang, Yanhang Gao
The management of AH is still controversial. The combination of static (MELD score) and dynamic (Lille’s score) approaches is the most accurate way to predict patient outcomes. Infection control is paramount and may be useful in predicting treatment responses. Abstinence from alcohol and provisions for EN are both essential for treatment success. When mDF scores are >54, the combination therapy of PTX plus CSs is the best option. When patients with SAH are not responsive to glucocorticoids, liver transplantation is a sound option with low relapse rates. Apart from this approach, new therapies, including G-CSF, liver dialysis/plasmapheresis, FMT, IL-22 and CSs plus IV NAC for 2–4 weeks, may be effective choices. Liver transplantation should be offered to select patients with SAH who are nonresponsive to conventional medical treatments.