Autologous Stem Cell Transplantation for Expansion of Remnant Liver Volume with Extensive Hepatectomy

Abstract

Background/Aims: The plasticity of bone marrow stem cells has been confirmed to self-renew and transdifferentiate into hepatocytes. Thus, we performed autologous stem cell transplantation for rapid liver regeneration with extensive hepatectomy in hepatocellular cancer patients. Methodology: With in formed consent, patients aged 20 to 75 who needed large extensive hepatectomy due to hepatocellular carcinoma were randomly divided into three groups: control, mononuclear cells (MNCs), and CD34+ cells, based on infused cell type. After portal vein embolization (PVE), mobilized MNCs or CD34+ cells were returned to the patient via the portal vein on mobilization day without manipulation. Liver volume, liver function, Clinical score and Indocyanine green R15 (ICG-R15) were compared before and after PVE. Results: Total bilirubin, albumin, and clinical score showed significant improvement (p < 0.05) 1 week post-infusion, with no significant difference between MNC and CD34+ cell groups. Four patients (control, 1; MNC, 1; CD34+, 2) started at over 18% ICG-R15 but can be overturned after PVE. Daily hepatic volume growth (mL/day) was 2.5 for MNC and 4.9 for CD34+ groups, resulting in significant increase over controls (1.1; p < 0.05). We found no correlation between the number of applied CD34+ cells and daily gains in left lateral lobe volume. Conclusions: Improvements in liver volume, liver function, clinical score and ICG-R15 suggest that autologous stem cell transplantation is a promising method for liver regeneration.