By Morgan Fincham, AASLD Staff
Dr. Scott Nyberg, a liver transplant surgeon at the Mayo Clinic since 1996, was an invited speaker at AASLD’s Clinical Research Single Topic Conference Intensive Care of the Patient with Acute on Chronic Liver Failure, recently held in Atlanta, GA. His involvement in artificial liver devices over the last 20 years made him the ideal candidate to discuss artificial and bioartificial support devices to “bridge a gap to transplant for people that have liver failure.”
A Single Topic Conference on ACLF has never been held before. Dr. Nyberg was pleased this was organized; “the conference was very much needed and hopefully will start a Special Interest Group in AASLD.” The main purpose of the meeting was to educate people and then come up with a definition for ACLF. Dr. Nyberg clarifies: “the data isn’t available to specifically define. The definition is more of a hypothesis. To prove the definition is accurate you need data to support the hypothesis. Hopefully now that data can be obtained.”
Many excellent expert speakers were present. Given Dr. Nyberg’s special interest in artificial and bioartificial liver devices, he attended the break out session led by Dr. Rajiv Jalan following his presentation "Liver Assist Devices." “Twenty-five people attended the session,” Dr. Nyberg recalls, “all experts in liver support devices. Most [devices] come from Europe. None of the devices are approved in the US by the FDA. There is one ongoing trial called the Silver Study that uses the ELAD device that contains human liver cells.” The Silver trial is a randomized prospective pivotal trial in the US under FDA supervision. Another device from Europe called MARS, Molecular Adsorbents Recirculating System or albumin dialysis, has FDA approval for drug toxicity and overdose. MARS is under review by the FDA for the indication of hepatic encephalopathy. “One reason liver support devices haven’t been successful,” Dr. Nyberg discloses, “is there hasn’t been a good supply of human hepatocytes for the machines. In the future, it won’t just be dialysis but dialysis with liver living cells… and animals as bioreactors to mass produce human hepatocytes.”
Another stand-out presentation Dr. Nyberg enjoyed was by Dr. Jean Louis Vincent, discussing the management of patients in the Intensive Care Unit: Overview of Multiple System Organ Failure and Systemic Inflammatory Response Syndrome. Dr. Vincent helped develop some of the scoring systems used to evaluate ICU patients including those with ACLF. “He elaborated on the pros and cons,” Dr. Nyberg describes “of scoring systems. The best systems are practical and directed at easily measured medical problems.” Another presentation, by Dr. Ray Kim, Economic Burden of Acute on Chronic Liver Failure also caught Dr. Nyberg’s attention: “It’s always interesting to hear what the financial numbers are like.”
Dr. Nyberg teases: “I only met one other surgeon at the meeting.” He would like to see more surgeons involved in future meetings, which are necessary due to the continued lack of data that prevents a clear definition of ACLF. This group of patients really requires a subspecialist, not just a surgeon or hepatologist, and this conference aimed to broaden the knowledge and ability of those treating the intensive care patient with ACLF. “Putting it all into perspective is the important thing you get out of the meeting.” Dr. Nyberg recalls, “and what is the best way to evaluate these patients.” Hearing the different perspectives from the different expert speakers all converging to focus on treating these patients was the most valuable element gained.
“I was very impressed with the conference,” Dr. Nyberg praises. “I was pleasantly surprised the meeting went so well, since AASLD has never had a focused meeting on this topic. Great job organizing it and putting it together at a great venue.” Dr. Nyberg looks forward to future meetings focusing on ICU patients with ACLF as more data is gained.