Practical barriers to delivering autologous bone marrow stem cell therapy as an adjunct to liver resection

Liver resection has been associated with significant morbidity and mortality due to hepatic dysfunction or hepatic failure in the postoperative period. Autologous bone marrow stem cell (BMSC) therapy may offer the potential to enhance hepatic regeneration in this setting, perhaps increasing the safety of the procedure. Preclinical models and initial translational studies have suggested that autologous BMSC administration can facilitate hepatic regeneration following both acute and chronic liver disease. While translational studies have begun in chronic hepatic disease, translation to hepatic surgical indications has been limited. This review explores the practical barriers currently restricting the delivery of autologous stem cell therapies to enhance hepatic regeneration following liver resection including selection of cell type, cell isolation, therapy delivery, trial design, and assessment of efficacy.