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AIMS AND OBJECTIVES: To assess the safety and efficacy of stem cell therapy in patients with cirrhosis of the liver (LC) in the context of developing country with limited facilities for cell-based therapy and advanced technologies. MATERIALS AND METHODS: A total of 34 patients received granulocyte colony-stimulating factor at a dose of 30 IU, daily for 2 to 11 days to upregulate the numbers of white blood cells and stem cells. Subsequently, stem cells were isolated from the peripheral blood of LC patients in a closed chamber using a harvesting machine. Variable amounts of autologous stem cells were injected to LC patients for once. The patients were followed for 3 months and various factors related to safety and parameters of efficacy were analyzed in this interim report. RESULTS: Out of 34 patients available for final analysis, 3 months after the start of stem therapy, 4 patients died within this period. There was no significant alteration in biochemical parameters due to stem cell therapy, and patients also did not develop any features of acute liver failure indicating that short-term safety parameters of stem cell therapy may be acceptable. Stem cell therapy had a dominant effect on ascites of in this cohort. Although 24 of 34 patients had ascites at the start of therapy,ascites were found in 11 patients after one month and only 4 patients had ascites after 3 months. The positive role of stem cell therapy on ascites in LC patients may be attributed, even in part, to increased serum levels of albumin after therapy compared to basal levels (p <0.001). CONCLUSION: This first study about stem cell therapy in Bangladesh indicates that cell therapy may be accomplished in general hospitals of developing countries if the proper design and mild to moderate types of invasive approach is utilized. The apparent safety of administered stem cells in LC patients and the observed effect on ascites of LC patients inspire optimism about the installation of new and innovative therapy in Bangladesh. Future studies with phase I/II may with stem cell and others cell may be planned at Bangladesh in patients with LC and other intractable diseases with suitable control arms.How to cite this article: Mahtab MA, Akbar SMF, Begum M, Islam MA, Rahim MA, Noor-E-Alam SM, Alam MA, Khondaker FA, Moben AL, Mohsena M, Khan SI, Huq MZ, Munshi S, Hoque A, Haque SA. Stem Cell Therapy for Cirrhosis of Liver in Bangladesh: Specific Design Compatible for Developing Country. Euroasian J Hepatogastroenterol, 2018;8(2):121-125.
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INTRODUCTION: Decompensated cirrhosis is associated with significantly high mortality resulting from hepatic failure, and liver transplantation seems to be the only viable indication for its management. The objective of this study is to assess if granulocyte colony-stimulating factor (G-CSF), a stimulatory of stem cell in vivo, may be of any benefit for patients with decompensated cirrhosis of liver. MATERIALS AND METHODS: Seventeen consecutive patients with decompensated cirrhosis of liver were recruited in this prospective study. They received injection of G-CSF (30 IU) over a period of 6 weeks (12 injections) in addition to standard of care. RESULTS: Patients were followed up at the end of treatment and at 12 weeks of treatment. Treatment was well tolerated, and no significant adverse event was recorded in any patient. Fifteen out of 17 (88%) patients were alive at last follow-up. Although serum bilirubin, albumin, and prothrombin time improved in some patients, statistically significant improvement of Child-Pugh score could not be documented. CONCLUSION: The study establishes the safety of G-CSF therapy in patients with decompensated cirrhosis of liver. Besides, such therapy may also have survival benefit, although long-term follow-up is needed to assess its real utility in clinical perspectives.How to cite this article: Al Mahtab M, Alam SMN, Moben AL, Raihan R, Alam MA, Rahim MA, Uddin MH, Akbar SMF. Therapy Targeting Stem Cell in Patients with Decompensated Cirrhosis of Liver in a Tertiary Treatment Care Center of Bangladesh. Euroasian J Hepato-Gastroenterol 2017;7(1):113-115.
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BACKGROUND: Hepatic venous pressure gradient (HVPG) reflects the portal pressure in patients with cirrhotic portal hypertension. The aim of the study was to assess the relation of HVPG to variceal size, Child-Pugh status, and variceal bleeding. MATERIALS AND METHODS: A total of 96 patients with cirrhosis of liver were enrolled prospectively and each patient's HVPG level was measured via the transfemoral route. Clinical and biochemical evaluation and upper gastrointestinal (GI) endoscopy were done in each subject. Severity of cirrhosis was assessed by Child's status. RESULTS: The mean HVPG was higher in patients with Child's B and C (14.10 ± 7.56 and 13.64 ± 7.17 mm Hg respectively) compared with those of Child's A (10.15 ± 5.63 mm Hg). The levels of HVPG differed significantly between Child's classes A and B (p = 0.011) and Child's A and C (p = 0.041). The mean HVPG was also higher in bleeders compared with nonbleeders with large varices (17.7 ± 5.5 vs 14.9 ± 4.7 mmHg respectively; p = 0.006). CONCLUSION: Hepatic venous pressure gradient seems to be important to assess the severity of liver cirrhosis.How to cite this article: Al Mahtab M, Noor E Alam SM, Rahim MA, Alam MA, Khondaker FA, Moben AL, Mohsena M, Akbar SMF. Hepatic Venous Pressure Gradient Measurement in Bangladeshi Cirrhotic Patients: A Correlation with Child's Status, Variceal Size, and Bleeding. Euroasian J Hepato-Gastroenterol 2017;7(2):142-145.
