Ex vivo liver perfusion (EVLP) and total body washout (TBW) appear to be the most promising of numerous methods advocated for the treatment of acute hepatic failure. The efficiency of these two methods to clear bilirubin was compared in jaundiced dogs. Six-hour EVLP was performed in five dogs (group 1) by perfusing the portal vein of the ex vivo liver with the recipient's artery. Hepatic venous blood was returned to the recipient's vein by a pulsatile blood pump. Total body washout was performed in six dogs (group 2) using hypothermic cardiopulmonary bypass. All animals tolerated both procedures well. In group 1, serum bilirubin levels fell from 4.93 ± 2.60 (mean ± SD) to 0.86±0.28 mg/100 ml, a clearance rate of 78.38% ± 10.36%. In group 2, bilirubin levels fell from 6.74 ± 1.99 to 0.54 ± 0.32 mg/100 ml, a clearance rate of 91.62% ± 5.59%. The serum bilirubin clearance rate of TBW was significantly higher (13.34%) than that of EVLP (.025 > P>.01).
Wakabayashi A, Kubo T, Gilman P, Charney K, Connolly JE. Total Body Washout and Ex Vivo Liver Perfusion in Acute Hepatic FailureA Comparative Study. Arch Surg. 1974;109(1):52-56. doi:10.1001/archsurg.1974.01360010038008