Research Focus
Liver Therapy

The etiology of acute liver failure is mostly of toxic origin, e.g. drugs (paracetamol) and phalloidin (mushrooms), as well as infectious viral hepatitis. Acute liver failure causes progredient brain dysfunction leading to the patient´s death. This development usually occurs within 1-2 weeks.
Unfortunately donor organs are scarce and often of poor quality. However, a regeneration of the liver is principally possible. Thus, liver transplantation is the last resort with severe consequences for a disease with often temporary character. By temporarily replacing liver function, a bridging to transplantation would be possible even in the case of delayed organ replacement. More importantly, patients with the capacity to recover could be bridged to regeneration and would not require transplantation at all.

During the last years, so-called bioreactors have been developed utilizing isolated liver cells and a synthetic vascular system made of capillary (hollow fiber) membranes. Pumps transport the patient’s plasma through these capillaries, thereby enabling the metabolism of surrounding cells. Variations of the different models differ mainly in type and number of applied cells, and in the mode of cell supply.

The implementation of dialysis with relevant detoxification and cell-based biological support and the possible incorporation of liver progenitor cell transplantation. Technologies and therapeutic concepts are being investigated in order to promote a modular therapeutic approach and a clinical concept for the treatment of chronic and acute liver failure, including hepato-renal syndrome.

Extracorporeal liver therapy with different modules in one therapy concept for individual indications according to the actual clinical needs of the patient in the time course of liver failure. Liver progenitor cell transplantation may complete the concept, where the extracorporeal modules bridge the time to liver cell mediated organ regeneration. The clinical aim is to functionally relieve the failing organ until regeneration or until a donor organ becomes available for transplantation.

A modular technology platform for all relevant liver support therapies is under development. Therapy can begin early in the clinical course and the appropriate modules can be combined step by step. Modules can be upgraded as required, even during clinical application. Dialysis technologies (hepato-renal syndrome), relevant detoxification technologies (chronic liver failure) and cellbased biological support technology (acute liver failure) can be implemented. The cell module offers patient metabolism, synthesis and regulation. The concept enables broad acceptance for extracorporeal liver support, as well as lowering the hurdles for ICUs to start more complex and technologically advanced therapies.

Within the different departments, interdisciplinary work on the various components is organized, indication criteria for the relevant liver diseases are developed, and clinical parameters are evaluated. The clinical studies currently being performed or planned consider the following indications: acute decompensation of chronic liver failure; bridging to liver regeneration in acute liver failure; bridging to liver transplantation; liver support after small-for- size split liver transplantation; liver support after initial dysfunction of a liver transplant; patient stabilization prior to living donor split liver transplantation in fulminant liver failure; liver support enabling extended surgery to cure liver cancer.