Feasibility and safety of hepatic artery infusion of G-CSF mobilized peripheral blood CD34+ haematopoietic stem cells in patients with cirrhosis: A pilot study
Background: At present, orthotopic liver transplantation is the only therapeutic option for patients with end-stage liver disease. However, due to shortage of the donor organs, 50% of patients die while on the waiting list. Hence, a search for alternative treatment modalities is essential. Adult ste...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2013-01-01
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| Series: | Current Medicine Research and Practice |
| Subjects: | |
| Online Access: | http://www.cmrpjournal.org/article.asp?issn=2352-0817;year=2013;volume=3;issue=1;spage=5;epage=17;aulast=Arora |
| Summary: | Background: At present, orthotopic liver transplantation is the only therapeutic option for patients with end-stage liver disease. However, due to shortage of the donor organs, 50% of patients die while on the waiting list. Hence, a search for alternative treatment modalities is essential. Adult stem cell-based treatment is evolving as a viable clinical alternative. We conducted a pilot study to assess the feasibility and safety of hepatic artery (HA) infusion of granulocyte colony-stimulating factor (G-CSF) mobilized peripheral blood CD34+ haematopoietic stem cells (HSCs) in patients with cirrhosis of the liver. Patients and methods: Consecutive patients of cirrhosis were treated with 5 days of G-CSF stimulation for mobilization of peripheral blood HSCs (CD34+ cells). Patients who achieved a minimum CD34+ cell count of >10/mcL after G-CSF stimulation underwent apheresis. The cell suspension thus obtained after apheresis was then infused into the HA of these patients. The patients who failed to achieve the desired CD34+ cell count of >10/mcL did not undergo HA infusion. Patients of both the groups were followed up for 6 months for clinical and biochemical improvement in liver function, if any. Results: Of the 106 eligible patients, 12 patients (median age 53 years [range 44–63], 75% males) were included in the study. The median Child–Turcotte–Pugh (CTP) score was 10 (range 8–12) and the median Model for End-stage Liver Disease (MELD) score was 16 (range 10–23). All patients successfully completed the 5-day course of G-CSF stimulation without any adverse reactions. Eight of twelve (67%) patients could achieve the primary objective of the study (CD34+ cell count of >10/mcL). Six of these patients underwent apheresis and subsequent HA infusion of CD34+ cells, without any complications. There was significant improvement in the median CTP score in the HA infusion group which decreased by two points from the baseline. The CTP scores remained same in the G-CSF alone group. Similarly, there was improvement in the MELD scores in the HA infusion group at 6 months, while they remained same in the G-CSF alone group. Conclusions: HA infusion of G-CSF stimulated autologous CD34+ cells significantly improved the CTP and MELD scores which was maintained for 6 months. Five-day G-CSF stimulation is able to stimulate the bone marrow-derived CD34+ stem cells in about 67% cirrhotic patients. G-CSF stimulation, apheresis and HA infusion are safe procedures without any significant side-effects in cirrhotics. Thus, these procedures can be used as a safe bridge to transplantation in patients with decompensated cirrhosis. |
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| ISSN: | 2352-0817 2352-0825 |