Infusion of autologous bone marrow mononuclear cells through hepatic artery results in a short-term improvement of liver function in patients with chronic liver disease: a pilot randomized controlled study.
OBJECTIVE
This randomized controlled study evaluated the effect of autologous infusion of bone marrow cells (BMC) in patients with hepatic cirrhosis.


METHODS
Thirty patients on the liver transplant waiting list were randomly assigned to receive BMC therapy or no treatment. They were followed up for 1 year. The study was nonblinded. Autologous mononuclear-enriched BMC were infused into the hepatic artery; liver function scores/tests were chosen as endpoints to assess efficacy. Statistical analysis calculated mean relative changes (RC) from baseline and fitted a random-effects model.


RESULTS
Mean age, baseline model for end-stage liver disease, and Child-Pugh score were similar in both groups. Child-Pugh score improved in the first 90 days in the cell therapy group compared with controls (P = 0.017, BMC group RC = -8%, controls RC = +5%). The model for end-stage liver disease score remained stable in the treated patients (RC -2 to +6%), whereas it increased during follow-up in the control group (RC +6 to +18%). Albumin levels improved in the treatment arm, whereas they remained stable among controls in the first 90 days (P = 0.034; BMC group RC = +16%, control group RC = +2%). Bilirubin levels increased among controls, whereas they decreased in the therapy arm during the first 60 days; INR RC differences between groups reached up to 10%. The changes observed did not persist beyond 90 days.


CONCLUSIONS
Transplantation of autologous BMC into the hepatic artery improved liver function in patients with advanced cirrhosis in the first 90 days. However, larger studies are necessary to define the role of BMC therapy in cirrhotic patients. Repeated autologous BMC infusions or combination therapy with granulocyte-colony-stimulating factor might improve or sustain the treatment response.
Lyra
Andre Castro
AC
Hospital Sao Rafael and c-HUPES/Federal Univeristy of Bahia, Medicine-Gastro-Hepatology Service, Graz, Austria. aclyra@atarde.com.br
Soares
Milena Botelho Pereira
MB
da Silva
Luiz Flavio Maia
LF
Braga
Eduardo Lorens
EL
Oliveira
Sheilla A
SA
Fortes
Marcos Fraga
MF
Silva
Andre Goyanna Pinheiro
AG
Brustolim
Daniele
D
Genser
Bernd
B
Dos Santos
Ricardo Ribeiro
RR
Lyra
Luiz Guilherme Costa
LG
D000293:Adolescent; D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D016026:Bone Marrow Transplantation / Q000379:methods*; D002908:Chronic Disease; D004812:Epidemiologic Methods; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011517:Prothrombin Time; D012709:Serum Albumin / Q000378:metabolism; D014850:Waiting Lists; D055815:Young Adult
D012709:Serum Albumin; D001663:Bilirubin