Evaluation of Liver Regeneration With Autologous Peripheral Stem Cells

Evaluation of Liver Regeneration With Autologous Peripheral Stem Cells Transplantation in the Patient Needed Extensive Hepatectomy

For patient with liver cirrhosis who need to right or extended right hepatectomy, we will treat with autologous peripheral stem cells transplantation to facilitate liver regeneration. We will asses liver regeneration by evaluation of liver volume and liver function test.

1. Patients: 30 patients (10 patients in each 3 group)

2. Indication:

   • Patients with Primary hepatocellular carcinoma combined liver cirrhosis (Hepatitis B, C, Non-B Non-C)
   • Planned to right hepatectomy or extended right hepatectomy
   • Patients who need right portal vein embolization due to insufficient expected remnant liver volume (< 40%) or severe hepatic dysfunction(ICGR15>10%)
   • Child A classification
   • ICG R15 < 25%
   • Age : 20 - 70 years old
   • Expected life period > 3months
   • The patients who agreed to this study.

3. Contraindication

   • Patients who planned liver transplantation
   • Age <20 or >70 years old
   • Pregnant women
   • Patients on acute infection
   • Acute hepatic failure
   • Child class B or C
   • Heart failure
   • Existence of bleeding tendency : platelet < 30,000, INR > 2.2, Cr >2.5
   • Patients who did not agree to this study.

4. Allocation: We will allocate patients randomly to three group including control group.

5. Methods

   • Group 1: 4 days injection of G-CSF -> Plasma pheresis, Selection of CD34 cell -> Right portal vein embolization and infusion of CD34 cell into left portal vein.
   • Group 2: 4 days injection of G-CSF -> Plasma pheresis -> Right portal vein embolization and infusion of mononuclear cell into left portal vein.
   • Group 3 (control): Right portal vein embolization

   ( -> after 4 weeks, operation will be performed)

6. Evaluation: Change of liver volume, liver function test before and after portal vein embolization

Inclusion Criteria:

1. Patients with Primary hepatocellular carcinoma combined liver cirrhosis (Hepatitis B, C, Non-B Non-C)
2. Planned to right hepatectomy or extended right hepatectomy
3. Patients who need right portal vein embolization due to unsufficient expected remnant liver volume (< 40%) or severe hepatic dysfunction (ICG R15 > 10%)
4. Child A classification
5. ICG R15 < 25%
6. Age: 20 - 70 years old
7. Expected life period > 3months
8. The patients who agreed to this study

Exclusion Criteria:

1. Patients who planned liver transplantation
2. Age < 20 or > 70 years old
3. Pregnant women
4. Patients on acute infection
5. Acute hepatic failure
6. Child class B or C
7. Heart failure
8. Existence of bleeding tendency : platelet < 30,000, INR > 2.2, Cr >2.5
9. Patients who did not agree to this study