Long Term Data on Effect of Mobilized Peripheral Blood Autologous CD34+ Cell Infusion in Patients With Non- Viral Decompensated Cirrhosis: 958

INTRODUCTION: The paucity of organs for liver transplant coupled with rising cost have paved the way for research in alternative cell based therapies as a bridge to liver transplantation. Our initial published work with 6 months follow up have now been followed up for 3 years and the data is presented below METHODS: Cirrhotic patients of non-viral etiology were divided into 2 groups – standard of care (control, n = 23) or to receive autologous CD34+ cell infusion through hepatic artery (study group n = 22). Patient in study group were admitted in hospital and received Granulocyte Colony stimulating Factor (G-CSF) injections @ 520µgm per day for 3 consecutive days to mobilize CD34+ cells from the bone marrow. On Day 4, leukapheresis was done and CD34+ cells were isolated using CliniMAC magnetic cell sorter. The isolated CD34+ cells were infused into the hepatic artery under radiological guidance. The control group received standard of care treatment for liver cirrhosis and were worked up for liver transplantation as per protocol of the institute. Both groups were followed up every weekly for 4 weeks and then every month for 3 months and then 6 monthly for 3 years RESULTS: In control and study group, the cause of cirrhosis was cryptogenic in 18 (78.2%) and 16 (72.72%) and alcohol related in 5(21.7%) and 6(27.27%) respectively. The mean day 3 cell count (cells/µl) was 27.00 ± 20.43 with a viability (%) of 81.84 ± 11.99. and purity of 80-90%. Primary end point analysis revealed that at 4 weeks, the mean serum albumin in the study group increased significantly (2.83 ± 0.36 vs 2.43 ± 0.42, P = 0.001) when compared with controls. This improvement in albumin was however not sustained at 3 months. However, at the end of 3 months there was a statistically significant improvement in serum creatinine in the study group (0.96 ± 0.33 vs 1.42 ± 0.70, P = 0.01) which translated into a significant improvement in the MELD score (15.75 ± 5.13 vs 19.94 ± 6.68, P = 0.04) . However, when these patients were followed up for 3 years, there was no difference in the MELD score and mortality ( 6/23 vs 5/23 ) between the 2 groups CONCLUSION: Autologous CD 34 + cell infusion is safe and effectively improved liver function in the short term. However, when they were followed up for 3 years , no difference could be noted in both the arms. Since cirrhosis is a ongoing process, the possible role of repeated infusions needs to be studied or a combination of mesenchymal and hematopoietic stem cells may be more effective.