title: Isolated hepatocyte transplantation for Crigler-Najjar syndrome type 1.
abstract: Crigler-Najjar syndrome type 1 (CN1) is an inherited disorder characterized by the absence of hepatic uridine diphosphoglucuronate glucuronosyltransferase (UDPGT), the enzyme responsible for the conjugation and excretion of bilirubin. We performed allogenic hepatocyte transplantation (AHT) in a child with CN1, aiming to improve bilirubin glucuronidation in this condition. A 9-year-old boy with CN1 was prepared with plasmapheresis and immunosuppression with prednisolone and tacrolimus. When a graft was made available, 7.5 x 10(9) hepatocytes were isolated and infused into the portal vein percutaneously. After 2 weeks phenobarbitone was added to promote the enzymatic activity of UDPGT of the transplanted hepatocytes. Nocturnal phototherapy was continued throughout the studied period. Total bilirubin was considered a reliable marker of allogenic cell function. There was no significant variation of vital signs nor complications during the infusion. Mean +/- SD bilirubin level was 530 +/- 38 micromol/L before and 359 +/- 46 micromol/L after AHT (t-test, p < 0.001). However, the introduction of phenobarbitone was followed by a drop of tacrolimus level with increase of alanine aminotransferase (ALT) and increase of bilirubin. After standard treatment of cellular rejection bilirubin fell again but from then on it was maintained at a greater level. After discharge the patient experienced a further increase of bilirubin that returned to predischarge levels after readmission to the hospital. This was interpreted as poor compliance with phototherapy. Only partial correction of clinical jaundice and the poor tolerability to nocturnal phototherapy led the parents to refuse further hepatocyte infusions and request an orthotopic liver transplant. After 24 months the child is well, with good liver function on tacrolimus and prednisolone-based immunosuppression. Isolated AHT, though effective and safe, is not sufficient to correct CN1. Maintenance of adequate immunosuppression and family compliance are the main factors hampering the success of this procedure.
authors.affiliation: Department of Surgery and Gastroenterological Science, University of Padova, Padova, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ambrosino
authors.forename: Sergio
authors.initials: S
authors.lastname: Varotto
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Strom
authors.forename: Graziella
authors.initials: G
authors.lastname: Guariso
authors.forename: Elisa
authors.initials: E
authors.lastname: Franchin
authors.forename: Diego
authors.initials: D
authors.lastname: Miotto
authors.forename: Luciana
authors.initials: L
authors.lastname: Caenazzo
authors.forename: Stefano
authors.initials: S
authors.lastname: Basso
authors.forename: Paolo
authors.initials: P
authors.lastname: Carraro
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Valente
authors.forename: Davide
authors.initials: D
authors.lastname: D'Amico
authors.forename: Lucia
authors.initials: L
authors.lastname: Zancan
authors.forename: Lorenzo
authors.initials: L
authors.lastname: D'Antiga
mesh_terms: D002648:Child; D003414:Crigler-Najjar Syndrome / Q000097:blood / Q000628:therapy*; D006085:Graft Survival / Q000187:drug effects; D022781:Hepatocytes / Q000378:metabolism / Q000637:transplantation*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D016031:Liver Transplantation; D008297:Male