Autologous bone marrow infusion via portal vein combined with splenectomy for decompensated liver cirrhosis: A retrospective study

doi:10.4240/wjgs.v15.i9.1919

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World Journal of Gastrointestinal Surgery

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1948-9366

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Retrospective Study

World J Gastrointest Surg. Sep 27, 2023; 15(9): 1919-1931
Published online Sep 27, 2023. doi: 10.4240/wjgs.v15.i9.1919

Autologous bone marrow infusion via portal vein combined with splenectomy for decompensated liver cirrhosis: A retrospective study

Bao-Chi Liu, Ming-Rong Cheng, Lin Lang, Lei Li, Yan-Hui Si, Ai-Jun Li, Qing Xu, Hui Zhang

Bao-Chi Liu, Lei Li, Yan-Hui Si, Department of Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China

Bao-Chi Liu, Lin Lang, He Nuo Medical Clinic, Shanghai New Hongqiao International Medical Center, Shanghai 201100, China

Ming-Rong Cheng, Department of Anorectal Surgery, The Third Affiliated Hospital of Guizhou Medical University, Duyun 558000, Guizhou Province, China

Ai-Jun Li, Department of Hepatobiliary Surgery, Oriental Hepatobiliary Surgery Hospital, Shanghai 200433, China

Qing Xu, Department of Hepatobiliary Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China

Hui Zhang, Department of Hepatobiliary Surgery, Shanghai Oriental Hospital Affiliated to Tongji University, Shanghai 200120, China

Author contributions: Liu BC outlined the content and reviewed the manuscript; Cheng MR reviewed the literature and wrote the manuscript; Lang L, Li L and Si YH performed this experimental work and analyzed the data; Li AJ, Xu Q and Zhang H participated in the experiments; Liu BC and Cheng MR contributed equally as joint first authors.

Supported by Shenkang Hospital Development Center of Shanghai, China, No. SHDC12016129.

Institutional review board statement: This study was approved by the Ethics Committee of the Shanghai Public Health Clinical Center (2013-030).

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: The authors declare that they have no competing interests.

Data sharing statement: No additional data are available.

Corresponding author: Bao-Chi Liu, Doctor, MD, Chief Physician, Department of Surgery, Shanghai Public Health Clinical Center, Fudan University, No. 2901 Caolang Road, Jinshan District, Shanghai 201508, China. liubaochi200227@aliyun.com

Received: April 6, 2023
Peer-review started: April 6, 2023
First decision: May 30, 2023
Revised: June 8, 2023
Accepted: July 11, 2023
Article in press: July 11, 2023
Published online: September 27, 2023
Processing time: 169 Days and 7.3 Hours

Abstract

BACKGROUND

In a previous study, autologous bone marrow infusion (ABMI) was performed in patients with decompensated liver cirrhosis (DLC) and acquired immunodeficiency syndrome and achieved good results, but whether splenectomy affected outcome was unclear.

AIM

To investigate the efficacy of ABMI combined with splenectomy for treatment of DLC.

METHODS

Eighty-three patients with DLC were divided into an intervention group (43 cases) and control group (40 cases) according to whether splenectomy was performed. The control group was treated with ABMI through the right omental vein, and the intervention group was additionally treated with splenectomy.

RESULTS

After ABMI, the prothrombin time, serum total bilirubin levels, ascites volume and model for end-stage liver disease score in both groups were significantly lower, while the albumin levels were significantly higher than before ABMI (P < 0.01), but there were no significant differences between the groups (P > 0.05). After ABMI, the white blood cell and platelets counts in both groups were significantly higher than before ABMI (P < 0.01), and the counts in the intervention group were significantly higher than in the control group (P < 0.01). After ABMI the CD4⁺ and CD8⁺ T cell counts in both groups were significantly higher than before ABMI (P < 0.01). The CD8⁺ T cell counts in the intervention group increased continuously and the increase had a shorter duration compared with control group.

CONCLUSION

ABMI through the portal vein in patients with DLC can significantly improve liver synthetic and secretory functions, and splenectomy promotes improvement of bone marrow hematopoietic and cellular immune functions.

Keywords: Autologous bone marrow; Splenectomy; Cell therapy; Cirrhosis; Cellular immunity

Core Tip: In this study, autologous bone marrow infusion (ABMI) through the portal vein in patients with decompensated liver cirrhosis (DLC) can significantly improve liver synthetic and secretory functions and is effective in patients with DLC. And it is the first attempt to investigate the impact of splenectomy on bone marrow hematopoietic function and cellular immune function after ABMI in patients with DLC.