CHICAGO - Interventional radiologists in Virginia and Nebraska have successfully experimented with the injection of frozen liver cells as a way to keep patients alive while they wait for liver transplants.
There were 14,000 people last year who required a new liver and only 5,000 who actually received one, said Dr. Jaime Tisnado at an RSNA press conference on Tuesday.
Tisnado, professor of cardiovascular and interventional radiology and surgery at the Medical College of Virginia/Virginia Commonwealth University in Richmond, authored one of two studies presented at the RSNA meeting; Dr. William Culp, assistant professor in radiology at the University of Nebraska Medical Center, worked on a second.
"Liver cells are more readily available than entire livers," Culp said. "Often organs are donated that are not good enough to use as an organ, but the cells are still good enough."
Anywhere from 200 million to 1 billion liver cells are stored in one infusion. When they are thawed, about 80% of the cells survive and are either injected directly into the liver, or into the spleen if the liver is cirrhotic or full of scar tissue. Ultrasound is used to guide the catheter into the portal vein of the liver; x-ray guidance is used to infuse cells into the spleen.
Tisnado performed the procedure on 12 patients in Virginia, including one 6-month-old infant. Of the dozen, one recovered with the cells alone, seven lived long enough to have a liver transplant and four died. The patient who recovered with only the cell injection had suffered a liver failure because of previous medication abuse. But because her liver was intrinsically normal, she recovered quickly, Tisnado said.
In Nebraska, five patients received cell transplantation including an infant born with a congenital liver defect. Because of the injection, the baby survived for five months until he received a new liver, Culp said. Another patient, an 11-year-old girl with a genetic liver defect was given the cells and was still alive two years later, he added.
Compared to a liver transplant, Culp said, "this technique has fewer side effects, less complications and is simple. The 11-year-old was in the hospital overnight. This is not the history of a liver transplant. This is the history of a tonsilectomy."
Despite the positive results, both doctors stressed that the procedure is still highly experimental. One major hurdle is the lack of available liver cells.
"We think that in the future, we're going to have banks of cells stored," Tisnado said. "Right now, we don't have that system. We only have cells stored for one or two patients at any time." The cells from one liver could be injected into as many as 20 people provided they are compatible, Tisnado estimated.
Another issue is immunosuppression, Culp said. Researchers are still trying to determine why some liver cells died while others survived and grew after the injection.
Assuming that cell transplant could be an alternative to liver transplant in some cases, Culp said he believed cell injection would cost less than a full liver transplant.
"It would be expensive, but a liver transplant is expensive: between a quarter and a third of a million dollars. (Cell transplantation) would be a great deal less," he said.
By Shalmali PalAuntMinnie.com staff writer
December 2, 1999
