AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION IN SUB-TERMINAL LIVER DISEASE PATIENTS

Back ground and objective: The ultimate goal of this work is to evaluate the effect of autologous hematopoietic stem cells transplantation as alternative therapeutic option in patients with sub terminal liver diseases. The work divided into 3 parts: Mobilization of CD34+ HSCs to peripheral blood, Leukapheresis, Intravenous infusion of autologous CD34+ HSCs to the patient. Patients and Method: 30 patients with HCV induced liver cirrhosis divided into 3 groups: Group I: consists of 10 patients with liver cirrhosis selected as Child C with scoring range from (14-21) this group was injected with G-CSF for 5 consecutive days to mobilize stem cells from the bone marrow to peripheral blood. Group II: consists of 10 patients with liver cirrhosis selected as Child C with scoring range from (16-23). This group was injected with granulocytes colony stimulating factor (G-CSF) 5 days before collection followed by leukapheresis and peripheral vein infusion of autologous hematopoietic stem cells CD34+ on day 6. Group III: control group consists of 10 cirrhotic patients maintained on supportive medical therapy. Results: The synthetic functions of liver in both groups I and II improved as evidenced by liver function tests (serum albumin, PT / INR& serum bilirubin) and MELD score after the procedure. Conclusion: Stem cell therapy is expected to be a last chance for patients suffering from end stage liver disease ESLD and waiting for donor livers. Consequently, decrease the need for orthotropic liver transplantation especially in the early stages of liver disease.