The Efficiency And Safety Of Acute-on-Chronic Liver Failure Treated With Mesenchymal Stem Cells:A Meta Analysis

Aims:We proformed a meta-analysis to evalutate the efficiency and safety of mesenchymal stem cells in treating acute-on-chronic liver failure.Methods:A clinical controlled studies for the treatment of acute-onchronic liver failure using mesenchymal stem cells as an intervention was obtained by reviewing the Chinese National Knowledge Infrastructure,Wanfang database,PubMed database,the Cochrane library and Google Scholar.The Primary outcomes were mortality rate.The secondary outcomes were the liver function,MELD score and adverse event.Metaanalysis was performed by suplying Stata12.0 software.Results:Four studies with 233 patients were included.Meta-analysis showed that mesenchymal stem cells transplantation could increase the survival rate of acute-on-chronic liver failure.The subgroup analysis with4-week[OR=2.77,95%CI(1.71-4.48),P<0.05],12-week[OR=2.77,95%CI(1.71-4.48),P<0.05]showed that the survival rate of MSCs treatment was higher than that of conventional treatment alone,and there was no statistically significant difference in the 24-week SR[OR=1.81,95%CI(0.93-3.51),P>0.05].A subgroup analysis based on different sources of MSCs showed that the survival rate of UCMSCs[OR=2.45,95%CI(1.35-3.45),P<0.05] or BM-MSC[OR=3.48,95%CI(1.53-7.91),P<0.05] was higher than that of conventional treatment alone.In terms of second outcome,the analysis showed the decrease of TBiL[SMD=-0.456,95%CI(-0.851-0.061),P<0.05] at 4-week,MELD score[SMD=-0.67,95%CI(-1.310-0.03,P=0.04] at12-week,INR[SMD=-0.44,95%CI(-0.50--0.07),P=0.04] at 24-week of MSCs treatmetn wassuperior to conventional treatment alone,and there was no statistically significant difference in second outcome at other observation times.Adverse event did not observed during the follow-up period.Conclusions:Our findings suggest that MSCs transplantation can significantly improve the short term survival rate in treating acute-onchronic liver failure.It has clinical application value as a safe cell therapy.The sample size of included studies in this analysis was small,therefore,clinical trials with bigger sample size and mutiple centers need to be conducted to evaluated the efficacy of MSCs treatment.looking forward to providing the basis of making puoductive therapeutic strategy.