title: Infusion of CD133+ bone marrow-derived stem cells after selective portal vein embolization enhances functional hepatic reserves after extended right hepatectomy: a retrospective single-center study.
abstract: OBJECTIVE
  This study was designed to evaluate the clinical outcome of patients undergoing portal vein embolization (PVE) and autologous CD133 bone marrow-derived stem cell (CD133+ BMSC) application before extended right hepatectomy.
  
  
  BACKGROUND
  We have previously shown that portal venous infusion of CD133+ BMSCs substantially increases hepatic proliferation, when compared with PVE alone.
  
  
  METHODS
  : Among 40 consecutive patients with a median follow-up of 28 months (7.4-57.2) scheduled for extended right hepatectomy, we compared a preconditioned group with PVE and CD133+ BMSC cotreatment (PVE+SC group, n = 11) and a group pretreated only with PVE (PVE group, n = 11). Functional and overall outcomes after extended right hepatectomy were evaluated. Patients without presurgical treatment served as controls (n = 18).
  
  
  RESULTS
  In preconditioned patients, mean hepatic growth of segments II/III 14 days after PVE in the PVE+SC group was significantly higher (138.66 mL ± 66.29) when compared with that of PVE group patients (62.95 mL ± 40.03; P = 0.004). There were no significant differences among all 3 groups regarding general and oncological characteristics and functional parameters on postoperative day (POD) 7. Lack of hepatic preconditioning, extrahepatic extension of resection, and postoperative complications were of negative prognostic value, using univariate analysis (P < 0.05). In multivariate analysis, freedom from postoperative major complications (P = 0.012), coagulation status on POD 7 (international normalized ratio < 1.4; P = 0.027), and presurgical expansion of the future liver remnant volume (P = 0.048) were positively associated with overall survival. Post hoc analysis revealed a better survival for the PVE+SC group (P = 0.028) compared with the PVE group (P = 0.094) and compared with controls.
  
  
  CONCLUSIONS
  Promising data from this survival analysis suggest that PVE, together with CD133+ BMSC pretreatment, could positively impact overall outcomes after extended right hepatectomy.
authors.affiliation: Department of General-, Visceral-, and Pediatric Surgery, Heinrich-Heine-University and University Hospital Düsseldorf, Germany.
authors.forename: Jan Schulte
authors.initials: JS
authors.lastname: am Esch
authors.forename: Moritz
authors.initials: M
authors.lastname: Schmelzle
authors.forename: Günther
authors.initials: G
authors.lastname: Fürst
authors.forename: Simon C
authors.initials: SC
authors.lastname: Robson
authors.forename: Andreas
authors.initials: A
authors.lastname: Krieg
authors.forename: Constanze
authors.initials: C
authors.lastname: Duhme
authors.forename: Roy Y
authors.initials: RY
authors.lastname: Tustas
authors.forename: Andrea
authors.initials: A
authors.lastname: Alexander
authors.forename: Hans M
authors.initials: HM
authors.lastname: Klein
authors.forename: Stefan A
authors.initials: SA
authors.lastname: Topp
authors.forename: Johannes G
authors.initials: JG
authors.lastname: Bode
authors.forename: Dieter
authors.initials: D
authors.lastname: Häussinger
authors.forename: Claus F
authors.initials: CF
authors.lastname: Eisenberger
authors.forename: Wolfram Trudo
authors.initials: WT
authors.lastname: Knoefel
mesh_terms: D000071916:AC133 Antigen; D000368:Aged; D015703:Antigens, CD; D016026:Bone Marrow Transplantation; D004621:Embolization, Therapeutic; D005260:Female; D006023:Glycoproteins; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008115:Liver Regeneration / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009367:Neoplasm Staging; D010455:Peptides; D011169:Portal Vein; D011183:Postoperative Complications / Q000401:mortality; D011300:Preoperative Care; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning
chemical_list: D000071916:AC133 Antigen; D015703:Antigens, CD; D006023:Glycoproteins; C000606023:PROM1 protein, human; D010455:Peptides