Background & Aim
Search for an effective therapy for patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) remains an important issue. This study investigated the efficacy of umbilical cord-derived mesenchymal stem cell (UC-MSC) transplantation in patients with HBV-ACLF.
45 consecutive entecavir-treated HBV-ACLF patients were prospectively studied. Among these patients, 11 received both plasma exchange (PE) and a single transplantation of UC-MSCs (group A), while 34 received only PE (group B). The primary endpoint was survival at 24 months.
Compared with group B, levels of albumin, alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin, prothrombin time (PT), international normalized ratio (INR) and model for end-stage liver disease score in group A improved significantly at 4 weeks after transplantation (p < 0.05). Levels of albumin, PT and INR in group A were also markedly improved at 24 months (p < 0.05). Group A had significantly higher cumulative survival rate at 24 months (54.5 % v.s. 26.5 %, p = 0.015 by log rank test). Between the two groups, levels of creatinine, White blood cell, hemoglobin and platelet were similar. HBeAg loss and hepatocellular carcinoma incidence were similar at 24 months. Group assignment (relative risk: 2.926, 95%confidence interval: 1.043–8.203, p = 0.041) was an independent predictor for survival at 24 months. Success rate of UC-MSC transplantation was 100 % in group A. No severe adverse event was observed in any patient.
UC-MSC transplantation is safe and effective for HBV-ACLF patients treated with PE and entecavir. It further improves the hepatic function and survival.
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Hepatitis B virus related acute-on-chronic liver failure
Artificial liver support systems
Mesenchymal stem cells
Bone marrow-derived MSCs
Umbilical cord-derived MSCs
International normalized ratio
Hepatitis B surface antigen
Hepatitis C virus
Hepatitis D virus
Human immunodeficiency virus
Complete blood count
Model for end-stage liver disease
White blood cell
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We kindly thank Prof. Jin-Hui Yang for his theoretical support and for permitting us to carry out this study. We thank Mr. Hong-Wei Wang from Shenzhen Baike Cell Engineering Research Institute for providing human UC-MSCs and instructing the clinical application of UC-MSCs. We thank interventional radiologists Prof. Ying-Chun Li and Song-Wei Li for their technical support in performing transplantation of UC-MSCs via the hepatic artery.
Conflict of Interest
The authors declare that they have no conflicts of interest.
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Li, YH., Xu, Y., Wu, HM. et al. Umbilical Cord-Derived Mesenchymal Stem Cell Transplantation in Hepatitis B Virus Related Acute-on-Chronic Liver Failure Treated with Plasma Exchange and Entecavir: a 24-Month Prospective Study. Stem Cell Rev and Rep 12, 645–653 (2016). https://doi.org/10.1007/s12015-016-9683-3
- Acute-on-chronic liver failure
- Mesenchymal stem cell
- Plasma exchange
- Hepatitis b virus
- Antiviral agents