title: Clinical outcome of hepatocyte transplantation in four pediatric patients with inherited metabolic diseases.
abstract: Hepatocyte transplantation (HT) has become an effective therapy for patients with metabolic inborn errors. We report the clinical outcome of four children with metabolic inborn errors that underwent HT, describing the cell infusion protocol and the metabolic outcome of transplanted  patients. Cryopreserved hepatocytes were used as this allows scheduling of treatments. Functional competence (viability, cell attachment, major cytochrome P450 and UDP-glucuronosyltransferase 1A1 activities, and urea synthesis) and microbiological safety of cell batches were assessed prior  to clinical use. Four pediatric patients with liver metabolic diseases [ornithine transcarbamylase (OTC) deficiency, Crigler-Najjar (CNI) syndrome, glycogen storage disease Ia (GSD-Ia), and tyrosinemia type I (TYR-I)] underwent HT. Indication for HT was based on severity of disease,  deterioration of quality of life, and benefits for the patients, with the ultimate goal to improve their clinical status whenever liver transplantation (LT) was not indicated or to bridge LT. Cells were infused into the portal vein while monitoring portal flow. The protocol included antibiotic  prophylaxis and immunosuppressant therapy. After HT, analytical data on the disease were obtained. The OTC-deficient patient showed a sustained decrease in plasma ammonia levels and increased urea production after HT. Further cell infusions could not be administered given a fatal nosocomial  fungus sepsis 2 weeks after the last HT. The CNI and GSD-Ia patients improved their clinical status after HT. They displayed reduced serum bilirubin levels (by ca. 50%) and absence of hypoglycaemic episodes, respectively. In both cases, the HT contributed to stabilize their clinical status  as LT was not indicated. In the infant with TYR-I, HT stabilized temporarily the biochemical parameters, resulting in the amelioration of his clinical status while diagnosis of the disease was unequivocally confirmed by full gene sequencing. In this patient, HT served as a bridge therapy to  LT.
authors.affiliation: Paediatric Gastroenterology and Hepatology Unit, University La Fe Hospital, Valencia, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Ribes-Koninckx
authors.forename: Eugenia Pareja
authors.initials: EP
authors.lastname: Ibars
authors.forename: Maria Ángeles
authors.initials: MÁ
authors.lastname: Calzado Agrasot
authors.forename: Ana
authors.initials: A
authors.lastname: Bonora-Centelles
authors.forename: Begoña Polo
authors.initials: BP
authors.lastname: Miquel
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Vila Carbó
authors.forename: Ester Donat
authors.initials: ED
authors.lastname: Aliaga
authors.forename: Jose Mir
authors.initials: JM
authors.lastname: Pallardó
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Gómez-Lechón
authors.forename: Jose V
authors.initials: JV
authors.lastname: Castell
mesh_terms: D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D017690:Cell Transplantation / Q000379:methods; D015925:Cryopreservation; D005260:Female; D022781:Hepatocytes / Q000166:cytology / Q000637:transplantation*; D006801:Humans; D008099:Liver / Q000166:cytology; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008659:Metabolic Diseases / Q000378:metabolism / Q000601:surgery*; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult