title: [Stem cell-induced liver regeneration].
abstract: BACKGROUND
  The liver has an excellent regenerative capacity after resection. However, below a critical level of future liver remnant volume (FLRV), partial hepatectomy is accompanied by a significant increase of postoperative liver failure. There is accumulating evidence for the contribution of bone marrow stem cells (BMSC) to participate in liver regeneration. Here we report our experience with portal vein embolisation (PVE) and CD133+ BMSC administration to the liver, compared with PVE alone, to augment hepatic regeneration in patients with critically low FLRV or impaired liver function.
  
  
  METHODS
  Eleven patients underwent PVE of liver segments I and IV-VIII to stimulate hepatic regeneration prior to extended right hepatectomy. In these 11 patients with a FLRV below 25% and/or limited quality of hepatic parenchyma, PVE alone did not promise adequate proliferation. These patients underwent additional BMSC administration to segments II and III. Two radiologists blinded to patients' identity and each other's results measured liver and tumour volumes with helical computed tomography. Absolute, relative and daily FLRV gains were compared with a group of patients that underwent PVE alone.
  
  
  RESULTS
  The increase of the mean absolute FLRV after PVE with BMSC application 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 after PVE alone (p<0.05). Also the relative gain of FLRV in this group (77.3%±38.2%) was significantly higher than that after PVE alone (39.1%±20.4%) (P=0.039). In addition, the daily hepatic growth rate after PVE and BMSC application (9.5±4.3 mL/d) was significantly superior to that after PVE alone (4.1±1.9 mL/d) (p=0.03). Time to surgery was 27 days±11 in this group and 45 days±21 after PVE alone (p=0.02). Short- and long-term survival were not negatively influenced by the shorter waiting period.
  
  
  CONCLUSIONS
  In patients with malignant liver lesions, the combination of PVE with CD133+ BMSC administration substantially increased hepatic regeneration compared with PVE alone. This procedure bears the potential to allow the safe resection of patients with a curative intention that would otherwise carry the risk post-operative liver failure.
authors.affiliation: Heinrich-Heine Universität Düsseldorf, Chirurgische Klinik A, Düsseldorf, Germany. knoefel@uni-duesseldorf.de
authors.forename: W T
authors.initials: WT
authors.lastname: Knoefel
authors.forename: A
authors.initials: A
authors.lastname: Alexander
authors.forename: R Y
authors.initials: RY
authors.lastname: Tustas
authors.forename: M
authors.initials: M
authors.lastname: Schmelzle
authors.forename: H-M
authors.initials: HM
authors.lastname: Klein
authors.forename: A
authors.initials: A
authors.lastname: Krieg
authors.forename: S A
authors.initials: SA
authors.lastname: Topp
authors.forename: C F
authors.initials: CF
authors.lastname: Eisenberger
authors.forename: G
authors.initials: G
authors.lastname: Fuerst
authors.forename: J
authors.initials: J
authors.lastname: Schulte am Esch
mesh_terms: D000071916:AC133 Antigen; D000368:Aged; D015703:Antigens, CD / Q000008:administration & dosage*; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D016026:Bone Marrow Transplantation / Q000379:methods*; D049109:Cell Proliferation / Q000187:drug effects; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006023:Glycoproteins / Q000008:administration & dosage*; D006498:Hepatectomy; D006801:Humans; D007262:Infusions, Intravenous; D019934:International Normalized Ratio; D017093:Liver Failure / Q000097:blood / Q000517:prevention & control; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008115:Liver Regeneration / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009929:Organ Size / Q000502:physiology; D010455:Peptides / Q000008:administration & dosage*; D011169:Portal Vein; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden / Q000502:physiology
chemical_list: D000071916:AC133 Antigen; D015703:Antigens, CD; D006023:Glycoproteins; C000606023:PROM1 protein, human; D010455:Peptides; D001219:Aspartate Aminotransferases; D001663:Bilirubin