Human mesenchymal stem cells for hepatitis B virus-related acute-on-chronic liver failure: a systematic review with meta-analysis.

BACKGROUND AND AIM: Acute-on-chronic liver failure (ACLF) is a condition with high mortality. New strategies are urgently required. The present review aims to provide a comprehensive understanding of the efficacy and safety of mesenchymal stem cells (MSC) treatment in patients with ACLF associated with hepatitis B virus infection.

MATERIALS AND METHODS: The MEDLINE, Embase, and Cochrane Library databases were searched for the relevant publications. If appropriate, a meta-analysis was carried out for the following outcomes: survival rate, model for end-stage liver disease score, and liver function.

RESULTS: Three studies were eligible for the present systematic review. A total of 198 hepatitis B virus-ACLF patients were enrolled for this review. Ninety-one patients were treated with MSC and 107 patients were treated with standard medical therapy (SMT) as controls. Pooled results showed that MSC treatment could significantly reduce the mortality rate at week 12 [risk ratio: 0.50; 95% confidence interval (CI): 0.33, 0.76; P=0.00009] and the mortality rate at the final follow-up (risk ratio: 0.54; 95%CI: 0.37, 0.78; P=0.001) compared with the SMT group. Furthermore, pooled estimates showed that MSC treatment could significantly reduce the total bilirubin level at week 4 (mean difference: 58.89; 95%CI: 14.47, 103.32; P=0.009) compared with the SMT group. No severe complication associated with MSC treatment was observed.

CONCLUSION: Our pooled results suggested that MSC treatment could significantly reduce the mortality rate, without increasing the incidence of severe complications.