Abstract
The aim of this study was to propose a stem cell therapy for hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) based on plasma exchange (PE) for peripheral blood stem cell (PBSC) collection and examine its safety and efficacy. Sixty patients (n=20 in each group) were randomized to PE (PE alone), granulocyte colony-stimulating factor (G-CSF) (PE after G-CSF treatment), and PBSC transplantation (PBSCT) (G-CSF, PE, PBSC collection and hepatic artery injection) groups. Patients were followed-up for 24 weeks. Liver function and adverse events were recorded. Survival analysis was performed. PBSCT improved blood ammonia levels at 1 week (P<0.05). The level of total bilirubin, international normalized ratio, and creatinine showed significant differences in the 4th week of treatment (P<0.05). The survival rates of the PE, G-CSF, and PBSCT groups were 50, 65, and 85% at 90 days (P=0.034). There was a significant difference in 90-day survival between the PE and PBSCT groups (P=0.021). The preliminary results suggested that PBSCT was safe, with a possibility of improved 90-day survival in patients with HBV-ACLF.
Highlights
Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is one of the most common types of liver failure in China and represents many challenges in clinical treatment [1]
There were no significant differences in baseline indicators, including age, biochemical indicators, international normalized ratio (INR), white blood cells (WBC), creatinine, a-fetoprotein, and hepatitis B virus (HBV) DNA among the three groups (Table 1)
Stem cell therapy can be used for recovery from endstage liver disease
Summary
Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is one of the most common types of liver failure in China and represents many challenges in clinical treatment [1]. Nucleoside analog with strong virus inhibition effect can improve the survival of HBV-ACLF patients, but severe inflammatory necrosis and deficient regeneration ability of hepatocytes make liver transplantation the only effective treatment for some patients with liver failure [3]. Growing evidence suggests that stem cell therapy could be a promising strategy for the treatment of liver failure by inhibiting liver inflammation, necrosis, and subsequent fibrosis [6]. These stem cells, including umbilical cord blood mesenchymal stem cells (UCBMSCs), bone mesenchymal stem cells (BMSCs), and peripheral blood stem cell (PBSCs), all have their strengths and weaknesses [6]. Gordon et al [17] extracted CD34+ PBSCs from granulocyte colony-stimulating factor (G-CSF)-mobilized
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