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Evaluation of haematopoietic stem cell transplantation in patients with liver cirrhosis class (Child B)

Thesis

Last updated: 06 Feb 2023

Subjects

-

Tags

Internal Medicine

Advisors

El-Garem, Nuaman, Amin, Muna A., Abou-Saif, Muhammad, Gabr, Hala

Authors

Barakat, Barakat El-Sayed

Accessioned

2017-07-12 06:42:47

Available

2017-07-12 06:42:47

type

M.D. Thesis

Abstract

Background: Heamatopoietic stem cells have the ability to transdifferntiate into other tissues. So this carries important implication for the treatment of many liver diseases. As there is a huge demand for liver transplantation but there never enough organs and the procedure is not always successful we can use bone marrow or umbilical cord stem cells to help treat liver diseases and reduce the need for liver transplantation. Aim of the work : This work aimed at studying the outcome of use of heamatopoietic stem cells which are cultured in special media with hepatocyte growth factor to transdifferntiate them into hepatocyte then transplant it by direct intra splenic injection to patients with Liver cirrhosis (child B). Patients &methods: - 27 patients with child B class liver cirrhosis divided into two groups: - group I (13 patients those who received BMSC transplantation and group II (14 patient not receiving BMSC acting as control group). Both groups undergo clinical evaluation by proper history taking and physical examination routine laboratory investigations and abdominal ultrasonography.Aspiration of bone marrow from iliac crest of group1 patients to obtain hematopoietic stem cells followed by in vitro culture of stem cells with the addition of hepatocyte growth factor and transplantation of hepatocytes regenerated from bone marrow stem cells to the patients by direct intra-splenic injection. Follow up of patients for 6 months after transplantation with monitoring of liver enzymes, prothrombin time and concentration, serum albumin .To evaluate outcome of haemetopoietic stem cell transplantation. Results:- after six months follow up, the study group values improve fairly maintaining however statistically significant improvement in albumin, INR, ascites and MELD score while the control group experienced significant deterioration in all parameters. Conclusion: The findings in this study may provide evidence for the beneficial effect of autologous BM derived heptocyte transplantation.The improvement at one month follow-up was definite, however, slight, this improvement was lost in some patients at follow-up which may be due to the death of injected cells. The hostile environment of the cirrhotic liver may not support the injected cells, or the cells do not have a growth advantage to survive. Patient selection may be a pivotal step in hepatocyte transplantation. Selection of patients with prominent synthetic defect, minor obstructive features & MELD (<20), will improve the results.

Issued

1 Jan 2013

DOI

http://dx.doi.org/10.21473/iknito-space/38398

Details

Type

Thesis

Created At

28 Jan 2023