By Deborah R. Dakins

An unprecedented collaboration between radiologists, surgeons, transplant specialists, and hepatologists is extending the life of some patients with liver failure while they await an organ for transplant.

About 14,000 patients currently await donor livers but only about 5000 transplants occur annually. The new interventional radiology technique, which involves injection of frozen liver cells into the livers or spleens of patients, can keep the liver functioning for a few days or months until a transplant can occur. Two scientific papers outlining the research at two different institutions were presented at the RSNA meeting on Tuesday.

The technique is most beneficial for patients in whom liver failure occurs without warning and a transplant organ is not immediately available. It has the potential, however, to address the vast disparity between clinical demand for liver organs and the supply actually available.

Still experimental, the procedure has been tried in 12 patients at the Medical College of Virginia, by a team directed by Dr. Jaime Tisnado, a professor of cardiovascular and interventional radiology and surgery. MCV maintains a frozen liver cell bank expressly for this purpose.

In one of those patients, recovery after liver cell infusion was so successful that the patient did not require an organ transplant. Seven additional patients are alive after receiving liver transplants and four died while awaiting an organ. One patient suffered a complication after cell transplantation but recovered completely.

"It's an important procedure, and so far, the results have been very encouraging," Tisnado said. "There are many more people waiting for livers than there are livers available for transplant. Infusing these cells can keep them alive while they wait."

The idea of treating liver failure is a relatively new concept, with techniques refined during the last 15 years, according to Dr. William Culp, a professor of radiology at the University of Nebraska, and author of a second study on the topic. Research in Nebraska has focused on infants with congenital liver failure. Of five patients who have undergone the cell infusion procedure, two are still alive and three have died.

"We are looking at this as a bridge to recovery as well as to organ transplant," he said.

For example, the procedure could be useful for infant patients, Culp said, because morbidity/mortality from liver transplant in the first few months of life is much higher than in even slightly older patients. The procedure keeps these tiny patients alive as they grow stronger, bigger, and more able to withstand the rigors of a transplant procedure.

"This is exciting-but preliminary-work, requiring a huge effort by many physicians working together," Culp said. "It's a tour de force. We are learning so much more about immune suppression, for example, and cell delivery, as a result of this experiment. And it couldn't be done without this kind of collaboration. It's a full team in the best sense."