Portal vein embolization and autologous CD133+ bone marrow stem cells for liver regeneration: initial experience.
OBJECTIVE
To prospectively evaluate the effectiveness of portal vein embolization (PVE) and CD133(+) bone marrow stem cell (BMSC) administration to the liver, compared with PVE alone, to augment hepatic regeneration in patients with large hepatic malignancies.


METHODS
The study was approved by the institutional ethics committee; informed consent was obtained. Thirteen patients underwent PVE of liver segments I and IV-VIII to stimulate hepatic regeneration prior to extended right hepatectomy. In six patients (three men, three women; mean age, 61 years; range, 46-72 years) with a future liver remnant volume (FLRV) below 25% and/or limited quality of hepatic parenchyma, PVE alone did not promise adequate proliferation. These patients underwent BMSC administration to segments II and III (group I). In seven patients (three men, four women; mean age, 69 years; range, 63-75 years) with an FLRV below 25%, PVE alone was performed (group II). Two radiologists blinded to patients' identity and each other's results measured liver and tumor volumes with helical computed tomography. Absolute, relative, and daily FLRV gains were compared by using the t test or the Wilcoxon test.


RESULTS
The increase of the mean absolute FLRV in group I from 239.3 mL +/- 103.5 (standard deviation) to 417.1 mL +/- 150.4 was significantly higher than that from 286.3 mL +/- 77.1 to 395.9 mL +/- 94.1 in group II (P = .049). The relative gain of FLRV after PVE in group I (77.3% +/- 38.2) was significantly higher than that in group II (39.1% +/- 20.4) (P = .039). The daily hepatic growth rate in group I (9.5 mL/d +/- 4.3) was significantly superior to that in group II (4.1 mL/d +/- 1.9) (P = .03). Time to surgery was 27 days +/- 11 in group I and 45 days +/- 21 in group II (P = .057).


CONCLUSIONS
In patients with malignant liver lesions, the combination of PVE with CD133(+) BMSC administration substantially increased hepatic regeneration compared with PVE alone.
Fürst
Günter
G
Institute of Diagnostic Radiology, Heinrich-Heine-University of Duesseldorf, Moorenstr 5, 40225 Duesseldorf, Germany.
Schulte am Esch
Jan
J
Poll
Ludger W
LW
Hosch
Stefan B
SB
Fritz
L Benjamin
LB
Klein
Michael
M
Godehardt
Erhard
E
Krieg
Andreas
A
Wecker
Britta
B
Stoldt
Volker
V
Stockschläder
Marcus
M
Eisenberger
Claus F
CF
Mödder
Ulrich
U
Knoefel
Wolfram T
WT
D000071916:AC133 Antigen; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D015703:Antigens, CD; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000628:therapy*; D018281:Cholangiocarcinoma / Q000628:therapy*; D015179:Colorectal Neoplasms / Q000473:pathology; D004621:Embolization, Therapeutic; D005260:Female; D006023:Glycoproteins; D018380:Hematopoietic Stem Cell Transplantation; D006412:Hematopoietic Stem Cells / Q000276:immunology; D006801:Humans; D019934:International Normalized Ratio; D008099:Liver / Q000502:physiology*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010455:Peptides; D011169:Portal Vein; D011300:Preoperative Care; D012038:Regeneration; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous
D000071916:AC133 Antigen; D015703:Antigens, CD; D006023:Glycoproteins; C000606023:PROM1 protein, human; D010455:Peptides; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin