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Omoyayi Ibrahim O.
20174831@std.neu.edu.tr
PhD. Biomedical Engineering
TISSUE ENGINEERING FOR LIVER REGENERATION
Outline
• Tissue Engineering / Regeneration
• The liver
– The function
– The diseases
• Research Problem and Question
• Current Approaches to liver diseases
• Liver Regeneration – The review
• Proposed methodology & result
• Conclusion
• List of References
Introduction
• Tissue Engineering is the reconstruction of cells to differential
cell into the desired tissue or organ in an attempt to improve
their structural functions.
• Regenerative medicine is an aspect of tissue engineering that
uses bioengineering principles to solve healthcare challenges
using new innovative ideas, methods and mode of synthesis
of different biomaterials construct.
• Tissue Regenerative Medicine uses scaffolding development
to guide cells into differentiating in to desired tissue or organ.
• Scaffolding provides an extracellular matrix for the cells, this
extracellular matrix serve and act as the guides for their
proper differentiation. (Hynes R.O, 2009)
• Other Emerging fields; Protein / Genetic / Clinical Engineering
Tissue Regenerative Medicine
The Liver
• The liver is a large, meaty organ (weighs about 3
pounds) that sits on the right side of the belly.
• Reddish-brown in color and feels rubbery to the
touch. You can't feel the liver, because it's
protected by the rib cage.
• The right and the left lobes.
• The gallbladder sits under
the liver
• Works with other organs to
digest, absorb, and process
food.
The Liver Cell Types
Ancient Mythology of the Liver
Titan Prometheus had a reputation as being
something of a clever trickster and he
famously gave the human race the gift of fire
and the skill of metalwork, an action for
which he was punished by Zeus, who ensured
everyday that an eagle ate the liver of the
Titan as he was helplessly chained to a rock
For students of tissue engineering and regenerative medicine, an
eagle fed from his liver each day, but the liver regenerated overnight is
something fascinating.
http://www.sciencedirect.com/science/article/pii/S0168827810003259
Function of The Liver
• Function as a biochemical defense
against toxic chemicals entering
through the food.
• Synthesis of bile is essential for
absorption of fat and lipophilic
nutrients.
• As a major regulator of plasma
glucose and ammonia levels.
• Essential for optimal function of the
brain. Loss of liver function leads to
chronic “hepatic encephalopathy”
and eventually coma.
Complications of The Liver
• Hepatitis: Inflammation of the liver, usually caused by viruses like hepatitis A, B,
and C. causes includes: heavy drinking, drugs, allergic reactions, or obesity.
• Cirrhosis: Long-term damage to the liver from any cause can lead to permanent
scarring, called cirrhosis. The liver then becomes unable to function well.
• Liver cancer: The most common type of liver cancer, hepatocellular carcinoma,
almost always occurs after cirrhosis is present.
• Liver failurae: Liver failure has many causes including infection, genetic diseases,
and excessive alcohol.
• Ascites: As cirrhosis results, the liver leaks fluid (ascites) into the belly, which
becomes distended and heavy.
• Gallstones: If a gallstone becomes stuck in the bile duct draining the liver, hepatitis
and bile duct infection (cholangitis) can result.
• Hemochromatosis: Hemochromatosis allows iron to deposit in the liver, damaging
it. The iron also deposits throughout the body, causing multiple other health
problems.
• Primary sclerosing cholangitis: A rare disease with unknown causes, primary
sclerosing cholangitis causes inflammation and scarring in the bile ducts in the liver.
• Primary biliary cirrhosis: In this rare disorder, an unclear process slowly destroys
the bile ducts in the liver. Permanent liver scarring (cirrhosis) eventually develops.
Research Problem
• Over 6500 liver transplant
are performed annually.
• There are currently 17,000
children and adults in the
US approved for a liver
transplant and waiting for
a donor liver.
• There seems to be no
noticeable increase in liver
donor.
Research Ideas?
Research Question
Current Approaches in Tissue Engineering
Current Approaches in Tissue Engineering
Current Approaches in Tissue Engineering
Current Approaches in Tissue Engineering
Culture Systems for Hepatocytes
Current Approaches to Liver Regeneration
Current Approaches to Liver Regeneration
Proposed Methodology & Result
• Silk Fibroin hydrogel had previously been synthesized
characterized and evaluated
• Using previous results as guide, hydrogel would be
synthesize and stabilize using several methodologies.
• Scaffolds would be fabricated
• Hepatocytes would be cultured and transferred to the
hydrogel to evaluate its regenerative abilities.
Hydrogel Optical Microscopy x20mg Naked Eye View of Hydrogel
SFHa x40mg
HAPPY LIVER HAPPY LIFE… THANK YOU
List of Reference
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[PubMed]
• 2. Adam R, Cailliez V, Majno P, et al. Normalised intrinsic mortality risk in liver transplantation: European Liver Transplant Registry study.
Lancet. 2000;356:621–627. [PubMed]
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1992;16:1–7. [PubMed]
• 4. de Rave S, Tilanus HW, van Der LJ, et al. The importance of orthotopic liver transplantation in acute hepatic failure. Transpl Int. 2002;15:29–
33. [PubMed]
• 5. Wall WJ, Adams PC. Liver transplantation for fulminant hepatic failure: North American experience. Liver Transpl Surg. 1995;1:178–182.
[PubMed]
• 6. Farmer DG, Anselmo DM, Ghobrial RM, et al. Liver transplantation for fulminant hepatic failure: experience with more than 200 patients
over a 17-year period. Ann Surg. 2003;237:666–676. [PMC free article] [PubMed]
• 7. United Network for Organ Sharing. Liver transplantation data 2002. Available at: www.unos.org.
• 8. Rahman TM, Hodgson HJ. Review article: liver support systems in acute hepatic failure. Aliment Pharmacol Ther. 1999;13:1255–1272.
[PubMed]
• 9. Stockmann HB, Hiemstra CA, Marquet RL, et al. Extracorporeal perfusion for the treatment of acute liver failure. Ann Surg. 2000;231:460–
470. [PMC free article] [PubMed]
• 10. Davenport A. Artificial hepatic support. Where are we now? Blood Purif. 2001;19:1–3. [PubMed]
• 11. Mito M. Hepatic assist: present and future. Artif Organs. 1986;10:214–218. [PubMed]
• 12. Kjaergard LL, Liu J, Als-Nielsen B, et al. Artificial and bioartificial support systems for acute and acute-on- chronic liver failure: a systematic
review. JAMA. 2003;289:217–222. [PubMed]
• 13. Kiley JE, Gundermann KJ, Lie TS. Ammonia intoxication treated by hemodialysis. N Engl J Med. 1958;25:1156–1161. [PubMed]
• 14. Opolon P, Rapin JR, Huguet C, et al. Hepatic failure coma (HFC) treated by polyacrylonitrile membrane (PAN) hemodialysis (HD). Trans Am
Soc Artif Intern Organs. 1976;22:701–710. [PubMed]
List of References
• 15. Knell AJ, Dukes DC. Dialysis procedures in acute liver coma. Lancet. 1976;2:402–403. [PubMed]
• 16. Matsubara S, Okabe K, Ouchi K, et al. Continuous removal of middle molecules by hemofiltration in patients with acute liver failure. Crit
Care Med. 1990;18:1331–1338. [PubMed]
• 17. Jones RC, Strader LD, Berry WC. Peritonela dialysis in liver coma. US Armed Forces Med J. 1959;10:977–982. [PubMed]
• 18. Agarwal R, Farber MO. Is continuous veno-venous hemofiltration for acetaminophen-induced acute liver and renal failure worthwhile?
Clin Nephrol. 2002;57:167–170. [PubMed]
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• 20. Sadamori H, Yagi T, Inagaki M, et al. High-flow-rate haemodiafiltration as a brain-support therapy proceeding to liver transplantation for
hyperacute fulminant hepatic failure. Eur J Gastroenterol Hepatol. 2002;14:435–439. [PubMed]
• 21. Mori T, Eguchi Y, Shimizu T, et al. A case of acute hepatic insufficiency treated with novel plasmapheresis plasma diafiltration for bridge
use until liver transplantation. Ther Apher. 2002;6:463–466. [PubMed]
• 22. Schlechter DC, Nealon TF, Gibbon JH. A simple extracorporeal device for reducing elevated blood ammonia levels. Surgery. 1958;44:892–
897. [PubMed]
• 23. Rozenbaum JL, Kramer MS, Raja R, et al. Resin hemoperfusion: a new treatment for acute drug intoxication. N Engl J Med. 1971;284:874–
883. [PubMed]
• 24. Juggi JS. Extracorporeal cation-exchange circuits in the treatment of hyperammonaemia of hepatic failure. Med J Aust. 1973;1:926–930.
[PubMed]
• 25. O'Grady JG, Gimson AE, O'Brien CJ, et al. Controlled trials of charcoal hemoperfusion and prognostic factors in fulminant hepatic failure.
Gastroenterology. 1988;94:1186–1192. [PubMed]
• 26. Ash SR. Hemodiabsorption in treatment of acute hepatic failure and chronic cirrhosis with ascites. Artif Organs. 1994;18:355–362.
[PubMed]
• 27. Yarmush ML, Dunn JC, Tompkins RG. Assessment of artificial liver support technology. Cell Transplant. 1992;1:323–341. [PubMed]
• 28. Flendrig LM. Development of a novel bioarticial liver [thesis]. Academic Medical Center, University of Amsterdam, Amsterdam, The
Netherlands; 1998.
• 29. Steiner C, Mitzner S. Experiences with MARS liver support therapy in liver failure: analysis of 176 patients of the International MARS
Registry. Liver. 2002;22(suppl 2):20–25. [PubMed]
List of References
• 30. Schmidt LE, Sorensen VR, Svendsen LB, et al. Hemodynamic changes during a single treatment with the molecular adsorbents recirculating
system in patients with acute-on-chronic liver failure. Liver Transpl. 2001;7:1034–1039. [PubMed]
• 31. Mitzner SR, Stange J, Klammt S, et al R. Improvement of hepatorenal syndrome with extracorporeal albumin dialysis MARS: results of a
prospective, randomized, controlled clinical trial. Liver Transpl. 2000;6:277–286. [PubMed]
• 32. Stange J, Hassanein TI, Mehta R, et al. The molecular adsorbents recycling system as a liver support system based on albumin dialysis: a
summary of preclinical investigations, prospective, randomized, controlled clinical trial, and clinical experience from 19 centers. Artif Organs.
2002;26:103–110. [PubMed]
• 33. Seige M, Kreymann B, Jeschke B, et al. Long-term treatment of patients with acute exacerbation of chronic liver failure by albumin dialysis.
Transplant Proc. 1999;31:1371–1375. [PubMed]
• 34. Lanjuan L, Qian Y, Jianrong H, et al. Severe hepatitis treated with an artificial liver support system. Int J Artif Organs. 2001;24:297–303.
[PubMed]
• 35. Ash SR. Extracorporeal blood detoxification by sorbents in treatment of hepatic encephalopathy. Adv Ren Replace Ther. 2002;9:3–18.
[PubMed]
• 36. Sorrentino F. Prime ricerche per la realizzazione di un fegato artificiale. Chir Patol Sperim. 1956;4:1401–1404.
• 37. Kimoto S. The artificial liver: experiments and clinical application. Trans Am Soc Artif Intern Organs. 1959;5:102–112.
• 38. Mikami J, Moto M, Nishimuro A, et al. Surgical treatment of acute liver failure. II: an experimental study of extracorporeal metabolism in
the artificial liver using slices of canine liver. Jpn J Gastroenterol. 1959;56:1022.
• 39. Nose Y, Mikami J, Kasai N, et al. An experimental artificial liver utilizing extracorporeal metabolism with sliced or granulated canine liver.
ASAIO Trans. 1963;9:358. [PubMed]
• 40. Abouna GM, Ganguly PK, Hamdy HM, et al. Extracorporeal liver perfusion system for successful hepatic support pending liver regeneration
or liver transplantation: a pre-clinical controlled trial. Transplantation. 1999;67:1576–1583. [PubMed]
• 41. Horslen SP, Hammel JM, Fristoe LW, et al. Extracorporeal liver perfusion using human and pig livers for acute liver failure. Transplantation.
2000;70:1472–1478. [PubMed]
• 42. Eiseman B, Liem DS, Raffucci F. Heterologous liver perfusion in treatment of hepatic failure. Ann Surg. 1965;162:329–345. [PMC free
article] [PubMed]a

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Tissue regeneration of the liver

  • 1. Omoyayi Ibrahim O. 20174831@std.neu.edu.tr PhD. Biomedical Engineering TISSUE ENGINEERING FOR LIVER REGENERATION
  • 2. Outline • Tissue Engineering / Regeneration • The liver – The function – The diseases • Research Problem and Question • Current Approaches to liver diseases • Liver Regeneration – The review • Proposed methodology & result • Conclusion • List of References
  • 3. Introduction • Tissue Engineering is the reconstruction of cells to differential cell into the desired tissue or organ in an attempt to improve their structural functions. • Regenerative medicine is an aspect of tissue engineering that uses bioengineering principles to solve healthcare challenges using new innovative ideas, methods and mode of synthesis of different biomaterials construct. • Tissue Regenerative Medicine uses scaffolding development to guide cells into differentiating in to desired tissue or organ. • Scaffolding provides an extracellular matrix for the cells, this extracellular matrix serve and act as the guides for their proper differentiation. (Hynes R.O, 2009) • Other Emerging fields; Protein / Genetic / Clinical Engineering
  • 5. The Liver • The liver is a large, meaty organ (weighs about 3 pounds) that sits on the right side of the belly. • Reddish-brown in color and feels rubbery to the touch. You can't feel the liver, because it's protected by the rib cage. • The right and the left lobes. • The gallbladder sits under the liver • Works with other organs to digest, absorb, and process food.
  • 7. Ancient Mythology of the Liver Titan Prometheus had a reputation as being something of a clever trickster and he famously gave the human race the gift of fire and the skill of metalwork, an action for which he was punished by Zeus, who ensured everyday that an eagle ate the liver of the Titan as he was helplessly chained to a rock For students of tissue engineering and regenerative medicine, an eagle fed from his liver each day, but the liver regenerated overnight is something fascinating. http://www.sciencedirect.com/science/article/pii/S0168827810003259
  • 8. Function of The Liver • Function as a biochemical defense against toxic chemicals entering through the food. • Synthesis of bile is essential for absorption of fat and lipophilic nutrients. • As a major regulator of plasma glucose and ammonia levels. • Essential for optimal function of the brain. Loss of liver function leads to chronic “hepatic encephalopathy” and eventually coma.
  • 9. Complications of The Liver • Hepatitis: Inflammation of the liver, usually caused by viruses like hepatitis A, B, and C. causes includes: heavy drinking, drugs, allergic reactions, or obesity. • Cirrhosis: Long-term damage to the liver from any cause can lead to permanent scarring, called cirrhosis. The liver then becomes unable to function well. • Liver cancer: The most common type of liver cancer, hepatocellular carcinoma, almost always occurs after cirrhosis is present. • Liver failurae: Liver failure has many causes including infection, genetic diseases, and excessive alcohol. • Ascites: As cirrhosis results, the liver leaks fluid (ascites) into the belly, which becomes distended and heavy. • Gallstones: If a gallstone becomes stuck in the bile duct draining the liver, hepatitis and bile duct infection (cholangitis) can result. • Hemochromatosis: Hemochromatosis allows iron to deposit in the liver, damaging it. The iron also deposits throughout the body, causing multiple other health problems. • Primary sclerosing cholangitis: A rare disease with unknown causes, primary sclerosing cholangitis causes inflammation and scarring in the bile ducts in the liver. • Primary biliary cirrhosis: In this rare disorder, an unclear process slowly destroys the bile ducts in the liver. Permanent liver scarring (cirrhosis) eventually develops.
  • 10. Research Problem • Over 6500 liver transplant are performed annually. • There are currently 17,000 children and adults in the US approved for a liver transplant and waiting for a donor liver. • There seems to be no noticeable increase in liver donor.
  • 13. Current Approaches in Tissue Engineering
  • 14. Current Approaches in Tissue Engineering
  • 15. Current Approaches in Tissue Engineering
  • 16. Current Approaches in Tissue Engineering
  • 17. Culture Systems for Hepatocytes
  • 18.
  • 19. Current Approaches to Liver Regeneration
  • 20. Current Approaches to Liver Regeneration
  • 21. Proposed Methodology & Result • Silk Fibroin hydrogel had previously been synthesized characterized and evaluated • Using previous results as guide, hydrogel would be synthesize and stabilize using several methodologies. • Scaffolds would be fabricated • Hepatocytes would be cultured and transferred to the hydrogel to evaluate its regenerative abilities. Hydrogel Optical Microscopy x20mg Naked Eye View of Hydrogel SFHa x40mg
  • 22. HAPPY LIVER HAPPY LIFE… THANK YOU
  • 23. List of Reference • 1. Bernuau J, Rueff B, Benhamou JP. Fulminant and subfulminant liver failure: definitions and causes. Semin Liver Dis. 1986;6:97–106. [PubMed] • 2. Adam R, Cailliez V, Majno P, et al. Normalised intrinsic mortality risk in liver transplantation: European Liver Transplant Registry study. Lancet. 2000;356:621–627. [PubMed] • 3. Lidofsky SD, Bass NM, Prager MC, et al. Intracranial pressure monitoring and liver transplantation for fulminant hepatic failure. Hepatology. 1992;16:1–7. [PubMed] • 4. de Rave S, Tilanus HW, van Der LJ, et al. The importance of orthotopic liver transplantation in acute hepatic failure. Transpl Int. 2002;15:29– 33. [PubMed] • 5. Wall WJ, Adams PC. Liver transplantation for fulminant hepatic failure: North American experience. Liver Transpl Surg. 1995;1:178–182. [PubMed] • 6. Farmer DG, Anselmo DM, Ghobrial RM, et al. Liver transplantation for fulminant hepatic failure: experience with more than 200 patients over a 17-year period. Ann Surg. 2003;237:666–676. [PMC free article] [PubMed] • 7. United Network for Organ Sharing. Liver transplantation data 2002. Available at: www.unos.org. • 8. Rahman TM, Hodgson HJ. Review article: liver support systems in acute hepatic failure. Aliment Pharmacol Ther. 1999;13:1255–1272. [PubMed] • 9. Stockmann HB, Hiemstra CA, Marquet RL, et al. Extracorporeal perfusion for the treatment of acute liver failure. Ann Surg. 2000;231:460– 470. [PMC free article] [PubMed] • 10. Davenport A. Artificial hepatic support. Where are we now? Blood Purif. 2001;19:1–3. [PubMed] • 11. Mito M. Hepatic assist: present and future. Artif Organs. 1986;10:214–218. [PubMed] • 12. Kjaergard LL, Liu J, Als-Nielsen B, et al. Artificial and bioartificial support systems for acute and acute-on- chronic liver failure: a systematic review. JAMA. 2003;289:217–222. [PubMed] • 13. Kiley JE, Gundermann KJ, Lie TS. Ammonia intoxication treated by hemodialysis. N Engl J Med. 1958;25:1156–1161. [PubMed] • 14. Opolon P, Rapin JR, Huguet C, et al. Hepatic failure coma (HFC) treated by polyacrylonitrile membrane (PAN) hemodialysis (HD). Trans Am Soc Artif Intern Organs. 1976;22:701–710. [PubMed]
  • 24. List of References • 15. Knell AJ, Dukes DC. Dialysis procedures in acute liver coma. Lancet. 1976;2:402–403. [PubMed] • 16. Matsubara S, Okabe K, Ouchi K, et al. Continuous removal of middle molecules by hemofiltration in patients with acute liver failure. Crit Care Med. 1990;18:1331–1338. [PubMed] • 17. Jones RC, Strader LD, Berry WC. Peritonela dialysis in liver coma. US Armed Forces Med J. 1959;10:977–982. [PubMed] • 18. Agarwal R, Farber MO. Is continuous veno-venous hemofiltration for acetaminophen-induced acute liver and renal failure worthwhile? Clin Nephrol. 2002;57:167–170. [PubMed] • 19. Bellomo R, Ronco C. Continuous hemofiltration in the intensive care unit. Crit Care. 2000;4:339–345. [PMC free article] [PubMed] • 20. Sadamori H, Yagi T, Inagaki M, et al. High-flow-rate haemodiafiltration as a brain-support therapy proceeding to liver transplantation for hyperacute fulminant hepatic failure. Eur J Gastroenterol Hepatol. 2002;14:435–439. [PubMed] • 21. Mori T, Eguchi Y, Shimizu T, et al. A case of acute hepatic insufficiency treated with novel plasmapheresis plasma diafiltration for bridge use until liver transplantation. Ther Apher. 2002;6:463–466. [PubMed] • 22. Schlechter DC, Nealon TF, Gibbon JH. A simple extracorporeal device for reducing elevated blood ammonia levels. Surgery. 1958;44:892– 897. [PubMed] • 23. Rozenbaum JL, Kramer MS, Raja R, et al. Resin hemoperfusion: a new treatment for acute drug intoxication. N Engl J Med. 1971;284:874– 883. [PubMed] • 24. Juggi JS. Extracorporeal cation-exchange circuits in the treatment of hyperammonaemia of hepatic failure. Med J Aust. 1973;1:926–930. [PubMed] • 25. O'Grady JG, Gimson AE, O'Brien CJ, et al. Controlled trials of charcoal hemoperfusion and prognostic factors in fulminant hepatic failure. Gastroenterology. 1988;94:1186–1192. [PubMed] • 26. Ash SR. Hemodiabsorption in treatment of acute hepatic failure and chronic cirrhosis with ascites. Artif Organs. 1994;18:355–362. [PubMed] • 27. Yarmush ML, Dunn JC, Tompkins RG. Assessment of artificial liver support technology. Cell Transplant. 1992;1:323–341. [PubMed] • 28. Flendrig LM. Development of a novel bioarticial liver [thesis]. Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; 1998. • 29. Steiner C, Mitzner S. Experiences with MARS liver support therapy in liver failure: analysis of 176 patients of the International MARS Registry. Liver. 2002;22(suppl 2):20–25. [PubMed]
  • 25. List of References • 30. Schmidt LE, Sorensen VR, Svendsen LB, et al. Hemodynamic changes during a single treatment with the molecular adsorbents recirculating system in patients with acute-on-chronic liver failure. Liver Transpl. 2001;7:1034–1039. [PubMed] • 31. Mitzner SR, Stange J, Klammt S, et al R. Improvement of hepatorenal syndrome with extracorporeal albumin dialysis MARS: results of a prospective, randomized, controlled clinical trial. Liver Transpl. 2000;6:277–286. [PubMed] • 32. Stange J, Hassanein TI, Mehta R, et al. The molecular adsorbents recycling system as a liver support system based on albumin dialysis: a summary of preclinical investigations, prospective, randomized, controlled clinical trial, and clinical experience from 19 centers. Artif Organs. 2002;26:103–110. [PubMed] • 33. Seige M, Kreymann B, Jeschke B, et al. Long-term treatment of patients with acute exacerbation of chronic liver failure by albumin dialysis. Transplant Proc. 1999;31:1371–1375. [PubMed] • 34. Lanjuan L, Qian Y, Jianrong H, et al. Severe hepatitis treated with an artificial liver support system. Int J Artif Organs. 2001;24:297–303. [PubMed] • 35. Ash SR. Extracorporeal blood detoxification by sorbents in treatment of hepatic encephalopathy. Adv Ren Replace Ther. 2002;9:3–18. [PubMed] • 36. Sorrentino F. Prime ricerche per la realizzazione di un fegato artificiale. Chir Patol Sperim. 1956;4:1401–1404. • 37. Kimoto S. The artificial liver: experiments and clinical application. Trans Am Soc Artif Intern Organs. 1959;5:102–112. • 38. Mikami J, Moto M, Nishimuro A, et al. Surgical treatment of acute liver failure. II: an experimental study of extracorporeal metabolism in the artificial liver using slices of canine liver. Jpn J Gastroenterol. 1959;56:1022. • 39. Nose Y, Mikami J, Kasai N, et al. An experimental artificial liver utilizing extracorporeal metabolism with sliced or granulated canine liver. ASAIO Trans. 1963;9:358. [PubMed] • 40. Abouna GM, Ganguly PK, Hamdy HM, et al. Extracorporeal liver perfusion system for successful hepatic support pending liver regeneration or liver transplantation: a pre-clinical controlled trial. Transplantation. 1999;67:1576–1583. [PubMed] • 41. Horslen SP, Hammel JM, Fristoe LW, et al. Extracorporeal liver perfusion using human and pig livers for acute liver failure. Transplantation. 2000;70:1472–1478. [PubMed] • 42. Eiseman B, Liem DS, Raffucci F. Heterologous liver perfusion in treatment of hepatic failure. Ann Surg. 1965;162:329–345. [PMC free article] [PubMed]a