title: Monitoring of intraportal liver cell application in children.
abstract: Despite recent advances and promising results in children, liver cell transplantation (LCT) should still be regarded as an experimental therapy. Several substantial complications are known from animal studies and individual patients. However, safety data on liver cell infusion in children are scarce. We used LCT in four children of different ages (3 weeks to 11 years, 3-40 kg) and underlying diseases [acute liver failure (n = 1), urea cycle disorders (n = 2), and Crigler-Najjar syndrome (n = 1)]. Vital parameters, portal vein flow (PVF), portal vein pressure (PVP), and liver enzymes were measured every 5 min during cell application and hourly thereafter between applications. An application protocol with discontinuation rules depending on changes in PVF and PVP was developed and successfully applied. Application was feasible in all children despite the catastrophic overall condition of the patient with acute liver failure. No application-related changes in vital parameters were found, and none of the children experienced clinical signs of portal vein thrombosis, pulmonary embolism, or anaphylactic reactions. Time courses for changes in PVF, PVP, and liver enzymes were obtained. Thorough monitoring of portal vein pressure and duplex sonography according to a defined protocol is likely to increase safety of cell application in pediatric LCT.
authors.affiliation: Department of General Pediatrics, University Children's Hospital, Heidelberg, Germany. jochen.meyburg@med.uni-heidelberg.de
authors.forename: Jochen
authors.initials: J
authors.lastname: Meyburg
authors.forename: Friederike
authors.initials: F
authors.lastname: Hoerster
authors.forename: Jan
authors.initials: J
authors.lastname: Schmidt
authors.forename: Johannes
authors.initials: J
authors.lastname: Poeschl
authors.forename: Georg F
authors.initials: GF
authors.lastname: Hoffmann
authors.forename: Jens-Peter
authors.initials: JP
authors.lastname: Schenk
mesh_terms: D017690:Cell Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D022781:Hepatocytes / Q000637:transplantation*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000098:blood supply / Q000166:cytology* / Q000601:surgery; D017114:Liver Failure, Acute / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D011169:Portal Vein