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PEDIATRICS Vol. 111 No. 6 June 2003, pp. 1262-1267

Isolated Hepatocyte Transplantation in an Infant With a Severe Urea Cycle Disorder

Simon P. Horslen, MB, ChB, FRCPCH*, Timothy C. McCowan, MD*, Timothy C. Goertzen, MD*, Phyllis I. Warkentin, MD*, Hung Bo Cai, MD, PhD{ddagger}, Stephen C. Strom, PhD{ddagger} and Ira J. Fox, MD*

* Sections of Pediatric Gastroenterology, Surgery, Radiology, and Pathology, University of Nebraska Medical Center, Omaha, Nebraska
{ddagger} Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Objective. Transplantation of isolated hepatocytes in animal models has been shown to correct inborn errors of metabolism. Based on these studies and our experience with hepatocyte transplantation in a child with Crigler-Najjar syndrome, isolated hepatocyte transplantation was performed to attempt metabolic reconstitution in a male infant with severe ornithine transcarbamylase (OTC) deficiency.

Methods. An infant with an antenatal diagnosis of OTC deficiency was managed intensively to prevent hyperammonemia. Isolated hepatocytes were obtained by collagenase perfusion of donated livers not used for transplantation. Hepatocytes were infused in batches over the first 4 weeks of life via an umbilical venous catheter positioned in the portal vein. Immunosuppression consisted of tacrolimus and corticosteroids.

Results. Over 4 billion viable hepatocytes were transplanted during the first 3.5 weeks of life. A period of metabolic stability was achieved between days 20 and 31 during which normal protein intake was tolerated while phenylbutyrate was weaned. During this time, plasma ammonia and glutamine remained within normal limits. Hyperammonemia reappeared abruptly on day 31 of life. Protein tolerance diminished to baseline; metabolic stability was subsequently reattained only following successful liver transplantation at 6 months of age.

Conclusions. Isolated hepatocyte transplantation appeared to result in temporary relief of hyperammonemia and protein intolerance attributable to OTC deficiency. The metabolic stability achieved was lost after 11 days presumably because of rejection of the transplanted cells because of insufficient immunosuppression. Future attempts at isolated hepatocyte transplantation for inborn errors of metabolism in humans should include adequate immunosuppression and a liver biopsy as a means of proving hepatocyte engraftment and function.

Key Words: hepatocyte transplantation • infant • ornthine transcarbamylase deficiency • urea cycle disorder

Abbreviations: OTC, ornithine transcarbamylase • DV, ductus venosus • OLT, orthotopic liver transplantation • IV, intravenous

Received for publication May 13, 2002; Accepted Sep 19, 2002.


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