title: Autologous hematopoietic stem cell transplantation in 48 patients with end-stage chronic liver diseases.
abstract: The only presently viable treatment for end-stage liver disease is whole organ transplantation. However, there are insufficient livers available. The aim of the present study is to provide autologous bone marrow-derived stem cells as a potential therapeutic for patients with end-stage cirrhosis. This is a retrospective chart review of autologous stem cell treatment in 48 patients, 36 with chronic end-stage hepatitis C-induced liver disease and 12 with end-stage autoimmune liver disease. For all patients, granulocyte colony-stimulating factor was administered to mobilize their hematopoietic stem cells. Following leukapheresis, CD34(+) stem cells were isolated, amplified, and partially differentiated in culture, then reinjected into each subject via their hepatic artery or portal vein. Treatment was generally well tolerated with the expected moderate but transient bone pain from G-CSF in less than half of the patients. Three patients had serious treatment-related complications, and only 20.8% of these end-stage liver disease patients died during 12 months of follow up. For all patients there was a statistically significant decrease in ascites. There was clinical and biochemical improvement in a large percentage of patients who received the transplantation. In the viral group, there were marked changes in albumin (p = 0.0003), bilirubin (p = 0.04), INR (p = 0.0003), and ALT levels (p = 0.02). In the autoimmune group, values also improved significantly for albumin (p = 0.001), bilirubin (p = 0.002), INR (p = .0005), and ALT levels (p = 0.003). These results suggest that autologous CD34(+) stem cell transplantation may be safely administered and appears to offer some therapeutic benefit to patients with both viral and autoimmune-induced end-stage liver disease.
authors.affiliation: Hepatology Department, Cairo University Hospital, Cairo, Egypt.
authors.forename: Hosny
authors.initials: H
authors.lastname: Salama
authors.forename: Abdel-Rahman
authors.initials: AR
authors.lastname: Zekri
authors.forename: Mark
authors.initials: M
authors.lastname: Zern
authors.forename: Abeer
authors.initials: A
authors.lastname: Bahnassy
authors.forename: Samah
authors.initials: S
authors.lastname: Loutfy
authors.forename: Sameh
authors.initials: S
authors.lastname: Shalaby
authors.forename: Cheryl
authors.initials: C
authors.lastname: Vigen
authors.forename: Wendy
authors.initials: W
authors.lastname: Burke
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mostafa
authors.forename: Eman
authors.initials: E
authors.lastname: Medhat
authors.forename: Omar
authors.initials: O
authors.lastname: Alfi
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Huttinger
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D018952:Antigens, CD34 / Q000378:metabolism; D001663:Bilirubin / Q000097:blood; D002908:Chronic Disease; D058625:End Stage Liver Disease / Q000628:therapy*; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D019934:International Normalized Ratio; D008875:Middle Aged; D011994:Recombinant Proteins; D012709:Serum Albumin / Q000032:analysis; D014182:Transplantation, Autologous
chemical_list: D018952:Antigens, CD34; D011994:Recombinant Proteins; D012709:Serum Albumin; D016179:Granulocyte Colony-Stimulating Factor; D000410:Alanine Transaminase; D001663:Bilirubin