Long-term Outcome of Autologous Hematopoietic Stem Cell Infusion in Cirrhosis: Waning Effect over Time

Background and Aims: Long-term data on cell-based therapies, including hematopoietic stem cell infusion in cirrhosis, are sparse and lacking. Methods: Patients with cirrhosis of non-viral etiology received either standard-of-care (n = 23) or autologous CD34+ cell infusion through the hepatic artery (n = 22). Study patients received granulocyte colony-stimulating factor (commonly known as G-CSF) injections at 520 mu gm per day for 3 days, followed by leukapheresis and CD34+ cell infusion into the hepatic artery. The Control group received standard-of-care treatment. Results: Mean CD34+ cell count on the third day of G-CSF injection was 27.00 +/- 20.43 cells/mu L 81.84 +/- 11.99 viability and purity of 80-90%. Significant improvement in the model of endstage liver disease (commonly known as MELD) score (15.75 +/- 5.13 vs. 19.94 +/- 6.68, p = 0.04) was noted at end of 3 months and 1 year (15.5 +/- 5.3 vs. 19.8 +/- 6.4, p = 0.04) but was not statistically different at end of the second (17.2 +/- 5.5 vs. 20.3 +/- 6.8, p = 0.17) and third-year (18.4 +/- 6.1 vs. 21.3 +/- 6.4, p = 0.25). No difference in mortality (6/23 vs. 5/23) was noted. Conclusions: Autologous CD34+ cell infusion effectively improved liver function and MELD score up to 1 year but the sustained benefit was not maintained at the end of 3 years, possibly due to ongoing progression of the underlying disease.