Autologous bone marrow mononuclear cell infusion for liver cirrhosis after the Kasai operation in children with biliary atresia

Abstract

Aim: To evaluate the safety and early outcomes of autologous bone marrow mononuclear cell (BMMNC) infusion for liver cirrhosis due to biliary atresia (BA) after Kasai operation.

Methods: An open-label clinical trial was performed from January 2017 to December 2019. Nineteen children with liver cirrhosis due to BA after Kasai operation were included. Bone marrow was harvested through anterior iliac crest puncture under general anesthesia. Mononuclear cells (MNCs) were isolated by Ficoll gradient centrifugation and then infused into the hepatic artery. The same procedure was repeated 6 months later. Serum bilirubin, albumin, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and prothrombin time were monitored at baseline, 3 months, 6 months, and 12 months after the first transplantation. Esophagoscopies and liver biopsies were performed in patients whose parents provided consent. Mixed-effect analysis was used to evaluate the changes in Pediatric End-Stage Liver Disease (PELD) scores.

Results: The average MNC and CD34+ cell counts per kg body weight were 50.1 ± 58.5 × 106/kg and 3.5 ± 2.8 × 106 for the first transplantation and 57.1 ± 42.0 × 106/kg and 3.7 ± 2.7 × 106 for the second transplantation. No severe adverse events associated with the cell therapy were observed in the patients. One patient died 5 months after the first infusion at a provincial hospital due to the rupture of esophageal varices, while 18 patients survived. Liver function was maintained or improved after infusion, as assessed by biochemical tests. The severity of the disease reduced markedly, with a significant reduction in PELD scores.

Conclusion: Autologous BMMNC administration for liver cirrhosis due to BA is safe and may maintain or improve liver function.

Trial registration: ClinicalTrials.gov identifier: NCT03468699. Name of the registry: Vinmec Research Institute of Stem Cell and Gene Technology. https://ichgcp.net/clinical-trials-registry/NCT03468699?cond=biliary+atresia&cntry=VN&draw=2&rank=2 . Registered on March 16, 2018. The trial results will also be published according to the CONSORT statement at conferences and reported in peer-reviewed journals.

Keywords: Biliary atresia; Bone marrow mononuclear cell infusion; Kasai operation.

Conflict of interest statement

The authors have declared that no competing interests exist.

© 2022. The Author(s).

Figures

Fig. 1

Liver function tests before and after BMMNCs administration, including a Serum bilirubin, b Alanine Aminotransferase, c Aspartate Aminotransferase, d Gamma-glutamyl transferase (GGT), e International Normalized Ratio (INR), f Albumin, g Prothrombin Time (PT)

Fig. 2

Esophagoscopy images from a patient show grade of varices changed from grade II to grade III. a Before administration, b after administration

Fig. 3

Cholestasis was not observed 12 months after BMMNCs administration. a Cholestasis in the biliary canaliculus (arrow), b cholestasis was no longer observed in biliary canaliculus

Fig. 4

Portal and periportal inflammation has disappeared at 12 months after BMMNCs administration. a Moderate portal and periportal inflammation with dense infiltration of lymphocytes and plasma cells. b inflammatory cells can no longer be observed in the portal and periportal areas

Fig. 5

PELD scores of 19 patients before and after BMMNCs administration