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Published online before print February 20, 2007, 10.1148/radiol.2431060625
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(Radiology 2007;243:171-179.)
© RSNA, 2007

Molecular Imaging

Portal Vein Embolization and Autologous CD133+ Bone Marrow Stem Cells for Liver Regeneration: Initial Experience1

Günter Fürst, MD, Jan Schulte am Esch, MD, Ludger W. Poll, MD, Stefan B. Hosch, MD, L. Benjamin Fritz, MD, Michael Klein, MD, Erhard Godehardt, MD, Andreas Krieg, MD, Britta Wecker, Volker Stoldt, MD, Marcus Stockschläder, MD, Claus F. Eisenberger, MD, Ulrich Mödder, MD and Wolfram T. Knoefel, MD

1 From the Institute of Diagnostic Radiology (G.F., L.W.P., L.B.F., B.W., U.M.) and Departments of General Surgery (J.S.a.E., S.B.H., A.K., C.F.E., W.T.K.), Cardiothoracic Surgery (M.K., E.G.), and Hemostaseology and Transfusion Medicine (V.S., M.S.), Heinrich-Heine-University of Duesseldorf, Moorenstr 5, 40225 Duesseldorf, Germany. Received April 7, 2006; revision requested June 5; final revision received June 19; accepted August 24. Address correspondence to L.B.F. (e-mail: ben{at}fritz.md).

Purpose: To prospectively evaluate the effectiveness of portal vein embolization (PVE) and CD133+ bone marrow stem cell (BMSC) administration to the liver, compared with PVE alone, to augment hepatic regeneration in patients with large hepatic malignancies.

Materials and Methods: The study was approved by the institutional ethics committee; informed consent was obtained. Thirteen patients underwent PVE of liver segments I and IV-VIII to stimulate hepatic regeneration prior to extended right hepatectomy. In six patients (three men, three women; mean age, 61 years; range, 46–72 years) with a future liver remnant volume (FLRV) below 25% and/or limited quality of hepatic parenchyma, PVE alone did not promise adequate proliferation. These patients underwent BMSC administration to segments II and III (group I). In seven patients (three men, four women; mean age, 69 years; range, 63–75 years) with an FLRV below 25%, PVE alone was performed (group II). Two radiologists blinded to patients' identity and each other's results measured liver and tumor volumes with helical computed tomography. Absolute, relative, and daily FLRV gains were compared by using the t test or the Wilcoxon test.

Results: The increase of the mean absolute FLRV in group I from 239.3 mL ± 103.5 (standard deviation) to 417.1 mL ± 150.4 was significantly higher than that from 286.3 mL ± 77.1 to 395.9 mL ± 94.1 in group II (P = .049). The relative gain of FLRV after PVE in group I (77.3% ± 38.2) was significantly higher than that in group II (39.1% ± 20.4) (P = .039). The daily hepatic growth rate in group I (9.5 mL/d ± 4.3) was significantly superior to that in group II (4.1 mL/d ± 1.9) (P = .03). Time to surgery was 27 days ± 11 in group I and 45 days ± 21 in group II (P = .057).

Conclusion: In patients with malignant liver lesions, the combination of PVE with CD133+ BMSC administration substantially increased hepatic regeneration compared with PVE alone.

© RSNA, 2007


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