Abstract
Acute on chronic liver failure (ACLF) is a newly recognized clinical entity with diverse etiology and an extremely high mortality rate. It may be rapidly fatal due to multi-organ failure. Liver transplantation (LT) is the best strategy for rescuing patients with ACLF. However, LT is not always possible due to donor shortage and/or high operation cost. The search for a strategy to provide temporary liver support and bridge the patients with ACLF to LT remains an important issue. Here, we report a case of hepatitis B virus (HBV) related ACLF patient who was successfully treated by repeated plasma exchange (PE) and umbilical cord-derived mesenchymal stem cell transfusion (UCMSC) in combination with antiviral therapy with entecavir (ETV).
Highlights
Acute-on-chronic liver failure (ACLF) is an acute and severe deterioration of liver function in a patient with chronic liver disease, and it has a high mortality [1,2]
Liver transplantation (LT) is identified as the most useful approach for Acute on chronic liver failure (ACLF); few patients benefit from this treatment due to the extreme lack of healthy livers and/or the costly operation [3]
We report a case of hepatitis B virus (HBV) related ACLF (HBVACLF) who was successfully treated by a combination of repeated Plasma exchange (PE) and Umbilical cord-derived mesenchymal stem cell (UC-MSC) transfusions in combination of antiviral therapy with entecavir (ETV)
Summary
Acute-on-chronic liver failure (ACLF) is an acute and severe deterioration of liver function in a patient with chronic liver disease, and it has a high mortality [1,2]. Abdominal computed tomography (CT) showed irregular liver edge, enlarged left lobe, ascites, enlarged spleen and gastric and esophageal varices (Figure 1) This patient was admitted to our department 3 times. One session of UC-MSC transfusion was implemented at the second and third hospital stay, respectively 2 units of commercially available UC-MSCs (60 × 106 cells) (Shenzhen Baike Cell Engineering Research Institute) were suspended in 60ml saline solution and delivered via a pump to the liver through proper hepatic artery (Figure 3). In this case, the patient received 3 sessions of UCMSC Transfusion on day 18, 87, 128. Alpha-fetpprotein (AFP) increased after each UC-SMC transfusion and returned to normal within 4 weeks (Figure 4)
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