Report from EASL; The European Association for the Study of the Liver Conference, Rotterdam, April 28-May 3, 2000 - Report 1

EASL Conference Day 1:

Today is Saturday in Rotterdam. After being tired and worn from overnight flight and arrival at 11 am in Rotterdam, I feel better today. The streets around my hotel are closed for a Rotterdam style street fair with bands, and lots of vendors selling goods just like a NY street fair. The people are generally friendly, the weather is similar to NY although yesterday it was 75 upon arrival. Last night I enjoyed a great meal in a Japanese restaurant across from my hotel where they grilled some great tasting fish on the grill right at the table.

This morning was the a pre-conference meeting on liver transplantation where speakers discussed the use of several different artifical liver support device systems and the use of a pig liver as a support for the patient who needs bridging to a transplant. There didn't appear to be adequate data on whether or not such approaches actually improve survival. The speakers said they felt unable to say whether or not such approaches improve survival but that such devices should be studied. In the Berlin experience there was no rejection in using the pig liver and no adverse events, but the chair of the session expressed caution in using animal livers and preferred study of artificial devices which would use human hepatocyte cells. The speaker said there are two ongoing studies exploring the feasability of 2 different particular support device systems.

Next was a discussion of high volume plasmapheresis as a treatment also for the patient needing a bridge to transplant. But in a follow-up talk in the hallway after the presentation, I learned that plasmapheresis has potential applicability in chronic hepatitis C infection. In this process an apparatus pumps blood out of the patient through the separator, removing about 60% of the plasma which is quantitatively by preheated replaced by fresh, frozen plasma and is returned to the patient. In other words, plasma or blood is removed from patient and replaced by fresh plasma. In high volume plasmapheresis this is done repeatedly to keep removing more and more toxins. I was told this could be done while a person remains on HCV therapy (IFN+RBV). This concept is not new. Several systems have been tried but to date no liver support system has demonstrated convincing and beneficial effects. It's suggested that repeated infusions as with high volume plasmapheresis may prove effective. I heard here there are several ongoing studies in the USA using this approach.