What is the d-LIVER Project?
d-LIVER is a four year project, funded by the ECs FP7 programme, developing technology to benefit patients with advanced liver disease. d-LIVER should result in improved care delivery leading to better patient quality of life and reduced costs of management. 14 partners across Europe are collaborating to provide a home monitoring system for patients with advanced liver disease alongside the development of a bio-artificial liver for potential use as an extracorporeal liver assist device. More details about each of these two strands of d-LIVER are given separately below.
d-LIVER Home Monitoring
The Clinical Need
We recognise that management of advanced liver disease can be complex: episodic decompensation, for example with ascites or hepatic encephalopathy, can occur unpredictably and often results in emergency admission to hospital. After inpatient treatment and stabilisation, patients are usually discharged to out-patient follow-up shared between primary and secondary care. Unfortunately, in spite of this follow-up, decompensation often recurs resulting in readmission to hospital. This cycle contributes to poor patient quality of life and leads to high treatment costs. d-LIVER aims to break the cycle by providing frequent, near-patient monitoring.
The d-LIVER Solution
d-LIVER home monitoring will allow regular monitoring of a variety of measurements, including blood parameters, physiological signs and cognitive testing. These will be carried out by patients independently in the home environment, but monitored remotely by clinicians. Semi-automated decision support will allow optimisation of treatment, for example diuretic therapy for ascites or laxatives for hepatic encephalopathy. It is envisaged that this approach will improve care through early detection or prevention of decompensation. Improved quality of life should result from reduced hospital admissions, improved clinical condition and greater self-efficacy.
d-LIVER Bio-Artificial Liver
In parallel with the home monitoring component, d-LIVER is also developing a Bio-Artificial Liver (BAL) assist device. It is envisaged that the BAL could provide support to patients in four clinical settings:
- Chronic liver failure: treatment of acute on chronic liver failure, for example reducing intermittent encephalopathy.
- Chronic cholestatic itch: intermittent long term-therapy in patients with refractory cholestatic itch could improve quality of life and reduce the need for transplantation.
- Bridging therapy before liver transplantation: treatment of high risk patients awaiting liver transplantation could reduce hospitalisation and waiting list mortality.
- Acute liver failure: support liver function for example in “small for size” patients.
Previous attempts to develop a cellular liver assist device have failed due to an inadequate supply of cells to carry out detoxification. Within d-LIVER we are investigating a variety of methods to provide a reliable supply of functional hepatocytes. A three-dimensional cell system or “bioreactor” will provide the interface between patient serum and cells. Constant monitoring of the bioreactor during a BAL therapy session will ensure that cells are maintained in optimum conditions.
d-LIVER: Technology to Give Liver Patients their Lives Back
The technology under development in the d-LIVER project is focused on providing improvements in care for liver patients, the majority of which can be delivered in the community. We believe that there are considerable gains to be made in patient quality of life by reducing the way in which advanced liver disease patients are often tied to the hospital. Instead, home-monitoring will allow decompensation to be prevented or identified early and the remote involvement of liver specialists should provide reassurance to patients. The development of Bio-Artificial Liver technology provides a potential novel therapy for the future.
If you have any questions, please feel free to e-mail us (with your own contact information) at: info(at)d-liver.eu.
Whole video demonstrating the motivation and the need for the d-LIVER project
Animation video explaining the BBI (Blood Biochemistry Instrument) of d-LIVER (Oct 2014)
How the d-Liver Project Can Help Chronic Liver Disease Sufferers, Futuris/Euronews (Nov 2014)