End stage liver disease / liver cirrhosis
The standard treatment for decompensated liver cirrhosis is liver transplantation. However, it has several limitations such as long waiting list, high cost, and several Complications. Stem cell therapy may be a potential alternative to liver transplantation
How it is done
Thorough evaluation with ultrasonography /CT scan and complete haematogical and biochemical tests including albumin and prothrombin time and a “model for end-stage liver disease” (MELD) score is done.
Under local anaesthesia 100 cc fat is aspirated. If possible approximately 150 cc of bone marrow is also aspirated from iliac crest or Tibia. In cases which are very compromised allogenic umbilical cord derived mesenchymal stem cells is also an option
Fat and bone marrow are processed to isolate various types of stem cells (haematopoietic, mesenchymal, endothelial and very small embryonic stem cells)
These cells are injected via angiographic guidance into the feeding artery of Liver. Alternatively intravenous route can be opted but it requires multiple administration of 4 times the amount of cells
What to expect /Results
- The doses of diuretics were reduced to half in 70 %.
- 60 % had good reduction in Ascites
- Appetite improved significantly in 60 %
- Liver function tests (abnormal serum albumin and/or bilirubin and/or prothrombin time/enzymes)
- Model for end-stage liver disease” (MELD) score improved significantly in 30 % of patients and were maintained till 2 years.
- The improvement was most significant by 4- 6 months post transplantation though changes could be observed as early as one week in some patients.
- The MELD score and liver function tests in 25 % remained stable (did not worsen) till 2 yrs
- CT showed that liver volumes in 30 % increased by six months post transplantation.
- SF-36 questionnaire showed that the quality of life of all patients had significantly till 2yrs follow up.
A) CT scans before, and
B) increased volume after Six months (White outline)