First stem cell liver transplant in Romania
A medical team coordinated by Prof. Dr. Irinel Popescu, head of the General Surgery and Liver Transplantation at Fundeni Institute, conducted the first stem cell liver transplant in Romania for a liver disease.
Correction of a metabolic defect
T.L. patient, aged 46 years, suffered from a metabolic disorder of the liver, which doctors hope to correct with cell transplantation. The case is a first in several ways. Initially, the patient suffered TL cirrhosis and liver cancer.
Against this background, in 2001 appeared more serious GI bleeding. During the crisis in Romania organ, the patient could not be transplanted with a liver from a brain-dead donor, because of position on the waiting list and associated cancer. “It was therefore proposed version transplantation” Domino “, which was diseased liver transplanted BM This patient suffered from birth with a genetic determinism condition called familial hypercholesterolemia. Because this disease, both in liver and in receptors are not synthesized outside the liver cholesterol, leading to cholesterol accumulation in various parts of the body, especially in the arteries. only solution was replacement therapy for patient BM liver, which was performed successfully on September 26, 2001.
However, with except metabolic defect that causes accumulation of cholesterol, the liver was normal. Therefore it was decided to use for sick liver TL, plus counting on the fact that this genetic defect was not welcoming, as such cholesterolic receptors could be synthesized, in some degree in tissues and organs located outside the liver. This hypothesis was confirmed. The patient TL, transplanted the same day (September 26, 2001) received liver from patient BM had a favorable postoperative evolution. Four years after the surgery is healed as cirrhosis and cancer, developing instead a moderate form of hypercholesterolemia, the following treatment. stem cell transplantation was performed to try to correct the metabolic defect, “said Prof. Dr. Irinel Popescu.
Cells placed in the hepatic artery
Lately, global gain increasingly more ground idea cell transplantation. In liver disease was first attempted transplant hepatocytes (cells that make up the normal liver). “The results were as expected, and preparing a mass sufficient to require the existence of a liver hepatocytes, which especially in countries where there is a chronic crisis of organs (such as Romania) is not always easy.
Transplantation of adult hepatocytes is at the same time, a alotransplant (from a donor with a different antigenic configuration) and requires permanent immunosuppression (as in organ transplantation), “said Prof. Dr. Irinel Popescu. Stem cells are primordial cells that can be prepared from both bone marrow and peripheral blood. Then infused in various organs, they turn into adult cells of the organ and take over the functions of its poor. Among the pioneers of the method include cardiologists, who used stem cell transplantation in patients with sequelae of myocardial infarction. Such interventions were performed in Romania, at the Timisoara Heart Institute.
Stem cell liver transplantation for a liver disease is a world premier almost absolute. Center of General Surgery and Liver Transplantation Fundeni was included in a study of Hammersmith Hospital in London, together with Cambridge University, in which were made during the year other 5 stem cell liver transplants to patients in the UK. In all 5 cases the indication for transplant was chronic liver disease (chronic hepatitis, cirrhosis), the expected result is improved liver function tests (transaminases, bilirubin, etc..). This effect was obtained in 3 of the 5 cases, a result which can be considered very promising.
Mrs. T.L. is patient number 6 in a trial of about 25 cases, coordinated by Professor Nagy Habib at Hammersmith Hospital in London. Cells were placed in the hepatic artery of the patient were prepared from peripheral blood of Cambridge University of the patient, which was harvested and prepared initially in Fundeni Institute.
The difference from when transplanted in the UK is that if the patient TL Liver tests are perfectly normal, expected effect of the transplant is a metabolic defect correction, accomplished by lowering cholesterol.
Intervention within the normal and sick feeling well today. Outcome of intervention will be made over two weeks considered the minimum time for processing blood stem cells from diseased adult liver cells.
If the trial started by British researchers confirm the efficiency of stem cell liver transplantation, are opening a series of great opportunities to treat these diseases. In many cases, liver disease can be permanently cured by this method, the others will get significant improvements and, finally, in other cases, the method can be used as a bridge (“Bridge”) in patients who are awaiting transplantation, but likely not reach major surgery due to deterioration of liver function.
In this intervention was attended by Dr. Marian Croitoru and Dr. Paul Plato, the Angiography Laboratory of the Institute of Cardiovascular Diseases “CC Iliescu”, Prof. Dr. Dan colitis, head of the bone marrow transplant program Fundeni Institute, Dr. Virginia Mirea, head of the blood transfusion center Fundeni Institute, Dr. Simona Dima, cell transplant specialist, Dr. Doina Hrehoret, responsible for tracking clinical liver transplant patients.