Experience of using mononuclear stem cells in combination with endovascular methods for the correction of portal hypertension in liver cirrhosis patients

Aim. To justify the necessity of combined intraportal administration of mononuclear stem cells, transjugular intrahepatic portosystemic shunting, and partial splenic embolization in patients with portal hypertension and hepatocellular insufficiency against the background of liver cirrhosis, to develop a technology, and to evaluate its safety and efficacy.

Materials and methods. The study involved the results of treatment for 1631 patients with liver cirrhosis of various etiologies from 2018 to 2023; 272 patients (16.7%) were included in the waiting list for cadaveric liver transplantation. During the waiting period, 195 patients (71.6%) underwent some method of surgical correction for portal hypertension: 84 patients (43.1%) underwent endoscopic ligation of esophageal varices, 46 patients (23.6%) had transjugular intrahepatic portosystemic shunting, 21 patients (10.7%) received partial splenic embolization, and 35 patients (17.9%) underwent both transjugular intrahepatic portosystemic shunting and partial splenic embolization in one procedure. In 15 cases (5.5%), intraportal administration of autologous bone marrow mononuclear cells was performed. In 9 cases (4.7%), this technology was combined with minimally invasive methods for correcting portal hypertension: in 6 cases (3.1%) with transjugular intrahepatic portosystemic shunting and in 3 cases (1.6%) with both transjugular intrahepatic portosystemic shunting and partial splenic embolization.

Results. Following the intraportal administration of autologous bone marrow mononuclear cells and minimally invasive surgical techniques for correcting complications of portal hypertension, no surgical complications or adverse events were observed. The average follow-up period for patients was 9 (3;15) months, with a MELD score during dynamic observation of 16 (12;18) points. No progression of complications related to portal hypertension was noted.

Conclusion. The combination of intraportal administration of autologous bone marrow mononuclear cells with minimally invasive methods for correcting complications of portal hypertension represents a promising, effective, and safe strategy for reducing mortality in patients awaiting cadaveric liver transplantation and improving treatment outcomes for patients with terminal diffuse liver diseases.

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