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المستخلص
BACKGROUND The worldwide shortage of donor livers has prompted the search for alternative cell therapies for patients suffering from end-stage liver disease, including the transplantation of stem/progenitor cells. Several potential sources have been identified of hepatic stem/ progenitor cells exhibiting differentiation towards the hepatic lineage in vitro and hepatic parenchymal repopulation with liver-specific metabolic activity
METHODS We report thirty liver cirrhosis (LC) patients that underwent autologous peripheral blood stem cell (PBSC) transplantation in the portal vein. Subjects were patients with LC with abnormal liver functions. G-CSF was administered to suitable patients to mobilize their haematopoietic stem cells (HSCs) from the bone marrow into the peripheral circulation. HSCs were isolated by leukapheresis, CD34+ cells were isolated and injected in the first group and expanded before injection in the second group. After stem cell therapy, liver function was monitored for 12 months.
RESULTS There was significant improvement as regards serum albumin and non-significant improvement as regards bilirubin levels and INR. There was improvement in the hepatic functional reserve as assessed by the Child-Pugh and MELD score. There was significant improvement as regards performance score (PS). By the end of the study, 40% showed improvement and none of the patients showed deterioration of the degree of ascites. The improvement was more persistent in the non-viral causes of LC (continued throughout the follow-up period) than the viral causes (improving for the initial 3 months then started to decline). On comparing non-expanded and expanded HSCs, only the serum albumin and PS displayed a significant difference. Safety of the procedure was evidenced by the low incidence of complications encountered: serum creatinine of all patients was within the normal range. 4 patients (13%) suffered attacks of haematemesis after 8 months. Only one patient had portal vein thrombosis and none had focal lesions.
CONCLUSIONS HSCs therapy may be considered a novel treatment for patients with decompensated LC.