Autologous bone marrow mononuclear cell transplantation in patients with decompensated alcoholic liver disease: a randomized controlled trial.
OBJECTIVE
Impaired liver regeneration is associated with a poor outcome in patients with decompensated alcoholic liver disease (ALD). We assessed whether autologous bone marrow mononuclear cell transplantation (BMMCT) improved liver function in decompensated ALD.


METHODS
58 patients (mean age 54 yrs; mean MELD score 19, all with cirrhosis, 81% with alcoholic steatohepatitis at baseline liver biopsy) were randomized early after hospital admission to standard medical therapy (SMT) alone (n = 30), including steroids in patients with a Maddrey's score ≥32, or combined with G-CSF injections and autologous BMMCT into the hepatic artery (n = 28). Bone marrow cells were harvested, isolated and reinfused the same day. The primary endpoint was a ≥3 points decrease in the MELD score at 3 months, corresponding to a clinically relevant improvement in liver function. Liver biopsy was repeated at week 4 to assess changes in Ki67+/CK7+ hepatic progenitor cells (HPC) compartment.


RESULTS
Both study groups were comparable at baseline. After 3 months, 2 and 4 patients died in the BMMCT and SMT groups, respectively. Adverse events were equally distributed between groups. Moderate alcohol relapse occurred in 31% of patients. The MELD score improved in parallel in both groups during follow-up with 18 patients (64%) from the BMMCT group and 18 patients (53%) from the SMT group reaching the primary endpoint (p = 0.43 (OR 1.6, CI 0.49-5.4) in an intention to treat analysis. Comparing liver biopsy at 4 weeks to baseline, steatosis improved (p<0.001), and proliferating HPC tended to decrease in both groups (-35 and -33%, respectively).


CONCLUSIONS
Autologous BMMCT, compared to SMT is a safe procedure but did not result in an expanded HPC compartment or improved liver function. These data suggest either insufficient regenerative stimulation after BMMCT or resistance to liver regenerative drive in patients with decompensated alcoholic cirrhosis.


BACKGROUND
Controlled-Trials.com ISRCTN83972743.
Division of Gastroenterology and Hepatology, University Hospitals and Faculty of Medicine, Geneva, Switzerland. Laurent.Spahr@hcuge.ch
Laurent
L
Spahr
Yves
Y
Chalandon
Sylvain
S
Terraz
Vincent
V
Kindler
Laura
L
Rubbia-Brandt
Jean-Louis
JL
Frossard
Romain
R
Breguet
Nicolas
N
Lanthier
Annarita
A
Farina
Jakob
J
Passweg
Christoph D
CD
Becker
Antoine
A
Hadengue
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D049109:Cell Proliferation; D016207:Cytokines / Q000097:blood; D005260:Female; D006499:Hepatic Artery / Q000601:surgery; D022781:Hepatocytes / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D008108:Liver Diseases, Alcoholic / Q000097:blood / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012038:Regeneration; D033581:Stem Cell Transplantation / Q000009:adverse effects; D013997:Time Factors; D014182:Transplantation, Autologous / Q000009:adverse effects; D055815:Young Adult
D015415:Biomarkers; D016207:Cytokines