Mamun Al Mahtab, Md. Abdur Rahim, Sheikh Mohammad Noor-E-Alam, Ashraful Alam, Faiz Ahmad Khondokar, Ahmed Lutful Moben
Introduction: Decompensated cirrhosis of liver is associated with decreased amounts of functional hepatocytes leading to compromised quality of life and increased mortality; Liver transplantation, the only curative option, is unavailable in Bangladesh. It is possible that autologous haemopoietic stem cells administered to liver aid in hepatocyte mobilization and reversal of decompensated cirrhosis. The study assessed safety and primary efficacy, if any, of autologous haemopoietic stem cell transplantation in patients with decompensated cirrhosis of liver for its future standardization.
Methods: Thirty-three patients with decompensated cirrhosis of liver were included after receiving ethical approval of Bangabandhu Sheikh Mujib Medical University (BSMMU). All patients received injection with granulocyte colony stimulating factor (G-CSF) (60 IU) s/c daily for 3-4 days along with standard medical therapy. CD34-positive cells were isolated from peripheral blood using cell sorter (Fresenius Kabi, Germany). Subsequently these were transfused trans-hepatic route into portal vein. Patients were then followed up initially for 90 days.
Results: Of the 33 study subjects 23 were males and 10 females. Their age was 50.6 years. 22 had hepatitis B, while 4 had NASH, 2 hepatitis C and 5 cryptogenic cirrhosis of liver. Mean serum bilirubin improved from 4.09 mg/dl at baseline to 1.87 mg/dl and 1.64 mg/dl at 30 and 90 days respectively. Mean serum albumin rose from 3.08 gm/L to 3.4 gm/L at 90 days. Mean prothrombin time showed improvement from 17.57 sec to 16.65 sec and 15.55 sec at 30 and 90 days. While moderate to marked ascites was present in 9 patients at baseline, 4 and 1 patient had similar ascites at 30 and 90 days respectively. 1/33 patient died within 90 days of follow up. Cause of death was hepatic encephalopathy. No significant rise in AFP and no hepatic SOL was detected in abdominal ultrasonography in any of the patients.
Conclusion: Autologous haemopoietic stem cell transplantation appears to be safe in patients with decompensated cirrhosis. Patients appear to be moderately benefitted with this approach.
Correspondence: Professor Mamun Al Mahtab, Chairman, Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka. Email: [email protected]