Autologous bone marrow cell transplantation in the treatment of HIV patients with compensated cirrhosis

Abstract

Liver stem cell therapy is a promising tool to improve decompensated liver cirrhosis (DLC). Especially in patients infected with human immunodeficiency virus (HIV), the condition of the liver may be aggravated by antiretroviral therapy. A total of 21 patients diagnosed with DLC and HIV infection were divided into two groups as follows: those who received (combination therapy group, 14 patients) and those who did not receive (routine therapy group, 7 patients) bone marrow cell transplantation through the portal vein. Two patients died of surgery-related complications in the combination therapy group. The results showed that the survival rate was 85.7% in the combination therapy group after 2 years of follow-up, which was significantly higher than the 14.3% in the conventional therapy group (P<0.01). After treatment, the liver function score decreased significantly in the combination therapy group at 1 (t = 4.276, P = 0.000), 3 (t = 9.153, P = 0.000), and 12 (t = 13.536, P = 0.000) months, the levels of albumin were significantly increased, and the total bilirubin level and prothrombin time were significantly reduced or shortened as compared with the routine therapy group (P<0.05 or <0.01). The white blood cell count, hemoglobin, platelet count, and CD4+ and CD8+ levels were significantly higher in the combination therapy group at different time points as compared with the routine therapy group (P<0.05 or <0.01). In summary, the combination therapy is effective in HIV-infected patients with DLC and useful for the recovery of liver function and cellular immune function but may increase the risk of severe complications after surgery.

Therapeutic effect of autologous bone marrow cells injected into the liver under the guidance of B‑ultrasound in the treatment of HBV‑related decompensated liver cirrhosis

“…demonstrated that the liver function in the control group was not significantly improved 12 months after treatment. Such patients with DLC are likely to gradually develop liver failure within 2 years if liver transplantation is not performed and only drugs such as those for liver protection (reduced glutathione) and diuresis (furosemide) are given (16). The present study demonstrated that the serum ALB, PT, serum TB and ascites levels were improved in observation group 2 at 1, 3, 6 and 12 months after treatment compared with the control group.…”

“…In 2009, our group started splenectomy and portal vein infusion of ABMNCs for the treatment of patients with DLC and acquired immunodeficiency syndrome, achieving good results (16). Subsequently, this method was applied to patients with DLC and HBV, achieving further improved results.…”

“…Therefore, it is expected to be a novel approach for the treatment of DLC. In a previous study, our team used an intravenous injection of autologous bone marrow nucleated cells (ABMNCs) administered through the right omental vein to treat patients with DLC and HIV, revealing marked improvements in the liver function and survival time of patients (16). However, due to the need for surgical catheterization, great trauma and poor compliance were observed.…”

Autologous bone marrow infusion via portal vein combined with splenectomy for decompensated liver cirrhosis: A retrospective study

“…CD4 + T cells are helper T cells, CD8 + T cells are cytotoxic T cells, and they secrete different cytokines to exert immune effects[ 36 ]. In a previous study, after ABMI through the ROV in the treatment of HIV patients with DLC[ 18 ], the CD8 + and CD4 + T cells showed obvious changes, and we found that CD8 + and CD4 + also changed in non-HIV patients with DLC, so we found that ABMI had an impact on immune function, so we retained these two indicators in the present study. We found that after ABMI, the CD4 + T cell count at each time point in the control and intervention groups was significantly higher than before ABMI, but there was no significant difference between the two groups.…”

“…Due to the rich blood supply and nutrients in the portal vein, stem cells stay in the liver sinusoids for a long time, with good selectivity distribution, and the portal system contains high concentrations of hepatotropic cytokines, which are important for the survival and growth of BMCs that are returned to the liver. In previous clinical trials surgery was performed to insert an infusion port into the right omental vein (ROV), autologous BMCs were returned through the infusion port, and good results were observed in the treatment of HIV patients with DLC[ 18 ]. However, it remains unclear whether splenectomy has an effect on patient outcomes.…”