P0227 REPEATED LIVER CELL TRANSPLANTATION VIA PORTH A CATH SYSTEM IN A CHILD

Abstract

Introduction: Liver cell transplantation is a novel experimental approach for the treatment of inborn errors of liver metabolism. We report a repeated cell infusion approach via a Porth A Cath system for the treatment of an eight year’s old girl with Crigler Najjar Syndrome. Methods: Hepatocytes were isolated from the left liver segment of one female and two male identical donors using the classical two step collagenase perfusion method. Cell recovery accounted for 3.8, 2.1, and 2.15 billions respectively, and viability ranged between 81 & 87 % (Trypan Blue exclusion method). A Porth A Cath system was inserted into a jejunal vein, and the access chamber placed subcutaneously in the left hypochondrion. 1.9 billion fresh isolated hepatocytes were first infused over two hours. The child received then five separate infusions for a total of 4.18 billion hepatocytes. The fourth first infusions used fresh liver cells, whereas cryopreserved cells were infused for the subsequent 5 infusions. The procedure was well tolerated, without any change in portal blood flow and portal pressure following the infusions. She received triple immunosuppression including anti IL2r antibodies (Simulect, Novartis, Bâle, Sw), tacrolimus (Fujisawa, Berlin, G) and steroids. Results: Transplantation efficiency was evaluated by measuring total Bilirubin levels, under identical phototherapy program. Mean bilirubin level during the five years before transplantation were 17.5±0.49 mg/dL. The level dropped to 16.16±0.31 mg/dL after the first infusions * p<0.05 and to 15.08±0.27 mg/dL after the second infusions. Six months after the first infusion, and the total of nine infusions, bilirubin levels had decreased progressively (13.6±0.42 mg/dL *** p<0.001) to reach the lowest value of 11.4 mg/dL. The effect of LCT was however not persistent, and bilirubin returned thereafter to pre- transplant values from month 6 post-LCT. The reason for the loss of metabolic effect could be rejection or apoptosis of transplanted cells. Conclusion: We conclude that liver cell transplantation can be done safely and repeatedly via a permanent portal access system, using a Porth A Cath. Metabolic effect in this case was temporary, which means that repopulation did not occur despite original efficient engraftment.