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PROMISING INTERVENTIONAL RADIOLOGY TECHNIQUE KEEPS PATIENTS ALIVE AS THEY AWAIT LIVER TRANSPLANT
CHICAGO --Transplanting liver cells that have been frozen may keep patients with liver failure alive as they await a new organ, and holds promise as a replacement for liver transplant in some patients, suggest two preliminary studies presented here today at the 85thScientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA).
"Although it's early and still experimental, this technique is very promising," said Jaime Tisnado, M.D., author of one of the studies and a professor of cardiovascular and interventional radiology and surgery at the Medical College of Virginia/Virginia Commonwealth University, Richmond. "We can keep these liver cells frozen in a bank, just as blood is stored.
"This procedure is very important, because there are many more people waiting for livers than there are livers available for transplant," said Dr. Tisnado. "Sometimes people become sick very suddenly, and there is no time to find and transplant a liver. Infusing these cells can keep them alive until we find an appropriate liver to transplant. In one case so far, a patient recovered after liver cell infusion only and did not need a transplant."
"Patients who are not candidates for liver transplant may also benefit from liver cell transplantation," said William C. Culp, M.D., an author of the second study and assistant professor in radiology at the University of Nebraska Medical Center. "It might provide a permanent repair job, or at least buy them some more time."
Currently, about 14,000 people are awaiting donor livers, but only about 5,000 receive transplants annually, according to the United Network of Organ Sharing.
Results from the Medical College of Virginia
Twelve patients received liver cell infusions at the Medical College of Virginia, including 1 6-month-old infant and 11 adults whose ages ranged from 23 to 63 years. Of the 12, 1 recovered with the cells alone, 7 are alive after having liver transplants and four died while awaiting transplant. One patient suffered a major complication after cell transplantation (infarction of the spleen), but recovered completely.
The liver cells used in the procedure are taken from one of several sources, usually from excess liver tissue of healthy donors that had not been used for transplant because it was too damaged to be cultured. In other cases, a living person has donated part of his or her liver to someone in need of a transplant, but there is more liver than required. The harvested cells are frozen, then stored in liquid nitrogen until ready for use.
As in whole-organ transplants, compatibility requirements have to be met for the cell transplant to occur. For instance, the blood type of the donor and recipient must match. Immunosuppression medication is given to all patients before and after transplant.
From 200 million to 1 billion liver cells are stored in each infusion. When needed, the cells are thawed -- about 80 percent to 90 percent of the cells survive -- and the cells are injected into the liver or spleen. If the liver is cirrhotic (hardened by disease) or full of scar tissue, the cells are injected into the spleen.
To infuse the cells into the liver, an interventional radiologist uses ultrasound guidance to insert a catheter, or small tube, through the abdomen into the portal vein, which carries blood to the liver. To infuse cells into the spleen, the interventional radiologist uses X-ray guidance to insert the catheter into an artery in the groin. From there, the catheter is advanced to the splenic artery, and the liver cells are deposited in the spleen.
The transplanted cells grow into the liver or spleen and start working immediately, said Dr. Tisnado.
Liver failure has many causes, including hepatitis, alcohol abuse, overdose of pain-killing drugs and infection.
"We have such a shortage of donors that this may be a good option for people who would otherwise die," said Dr. Tisnado. "It's enough to keep patients alive for a few days as they wait for a new liver. It eventually may become a permanent treatment for people with liver failure."
Results from the University of Nebraska
Five patients at the University of Nebraska Medical Center received liver cell transplantation, including two adults and three children. Two patients are still alive and three have died.
An infant born with a congenital liver defect (which was diagnosed in utero) was given cells immediately after birth. The cells helped him survive for 5 months until he could be given a liver transplant; he is now 1 year old. A 11-year-old girl with a genetic liver defect who was not sick enough for a liver transplant was given the cells, and is alive two years later. Her liver function has improved greatly, said Dr. Culp. Her phototherapy requirements have decreased 50 percent since treatment.
At 3 months old, a child born with a congenital liver defect received cells as a bridge to transplant and was given a liver transplant 2 weeks later. She died of post-transplant complications. Two adults with liver failure received liver cells and survived 26 and 37 days, respectively. Both had acute liver failure and neither was a candidate for transplantation.
The techniques for delivering the cells were the same as those used at the Medical College of Virginia, except in the 1-day-old infant, who was transfused with the cells through the umbilical cord.
"Some of the cells we used had been frozen, and others were fresh, taken from donor livers that were too traumatized to use for transplant, but had viable cells," said Dr. Culp.
An interventional radiologist is a physician who has special training in the diagnosis and treatment of illness using miniature surgical instruments and imaging guidance. Typically, the interventional radiologist performs procedures through a very small nick in the skin. Interventional radiology treatments are generally easier for the patient and less risky than surgery because they involve no surgical incisions, less pain and shorter hospital stays.
Co-authors of a paper on the topic being presented by Dr. Tisnado are: Uma R. Prasad, M.D.; Janice M. Newsome, M.D.; and Robert A. Fisher, M.D.
Co-authors of a paper on the topic being presented by Dr. Culp are: Timothy C. Goertzen, M.D.; Thomas G. Habbe, M.D.; Michael M. Hummel, M.D.; Timothy C. McCowan, M.D.; and Ira J. Fox, M.D.
The RSNA is an association of 31,000 radiologists and physicists in medicine dedicated to education and research in the science of radiology. The Society's headquarters are located at 820 Jorie Blvd., Oak Brook, Illinois 60523-2251.
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Note: Copies of 1999 RSNA news releases are available online at http://www.pcipr.com/rsna beginning Monday, Nov. 29.
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