Abstract
BackgroundStem cell therapy has been applied in the treatment of acute-on-chronic liver failure (ACLF). However, its clinical efficiency is still debatable. The aim of this systematic review and meta-analysis is to evaluate the clinical efficiency of stem cell therapy in the treatment of ACLF.MethodsThe Cochrane Library, OVID, EMBASE, and PUBMED were searched to December 2017. Both randomized and non-randomized studies, assessing stem cell therapy in patients with ACLF, were included. The outcome measures were total bilirubin (TBIL), alanine transaminase (ALT), international normalized ratio (INR), albumin (ALB), and the model for end-stage liver disease (MELD) score. The quality of evidence was assessed by GRADEpro.ResultsFour randomized controlled trials and six non-randomized controlled trials were included. The TBIL levels significantly decreased at 1-, 3-, 12-month after the stem cell therapy (p = 0.0008; p = 0.04; p = 0.007). The ALT levels decreased significantly compared with the control group in the short-term (p < 0.00001). There was no obvious change in the INR level compared with the control groups (p = 0.64). The ALB levels increased markedly as compared with the control groups (p < 0.0001). The significant difference can be found in MELD score between stem cell therapy and control groups (p = 0.008). Further subgroup analysis for 3-month clinical performance according to the stem cell types have also been performed.ConclusionThis study suggests that the clinical outcomes of stem cell therapy were satisfied in patients with ACLF in the short-term. MSCs may be better than BM-MNCs in the stem cells transplantation of ACLF. However, more attention should focus on clinical trials in large-volume centers.
Highlights
Stem cell therapy has been applied in the treatment of acute-on-chronic liver failure (ACLF)
The purpose of this review is to evaluate the clinical efficiency of stem cell therapy in the treatment of patients with ACLF
69 of these studies were excluded, 7 of which with no comparative studies, 10 of which were reviews and meta-analysis, 23 of which were excluded for undesired treatment or unexpected inclusion of participants, 12 of which were involved patients ACLF, 15 of which did not report the outcome interested, and 2 of which were unpublished by English
Summary
Stem cell therapy has been applied in the treatment of acute-on-chronic liver failure (ACLF). The aim of this systematic review and meta-analysis is to evaluate the clinical efficiency of stem cell therapy in the treatment of ACLF. Acute-on-chronic liver failure (ACLF) is a global medical problem, with high prevalence and being serious, life-threatening in risk populations [1, 2]. A novel therapeutic strategy, stem cell therapy, is beginning to apply in the treatment of ACLF. Stem cells are a kind of undifferentiated cells, which capable of unlimited proliferation [5]. Cells such as hematopoietic stem cells (HSCs), mesenchymal stem cells (MSCs) and unsorted bone marrow cells (BMCs) have all been used in the stem cell therapy for liver diseases.
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