Mesenchymal Stem Cell Transplantation For Hepatitis B Virus-Related Acute-on-Chronic Liver Failure: A Systematic Review and Meta-Analysis

Background: Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a severe complication with a poor prognosis. Recently, mesenchymal stem cell (MSC)-based therapy for HBVACLF has shown considerable promise. Therefore, this systematic review and meta-analysis aimed to evaluate the efficacy and safety of MSC transplantation for patients with HBV-ACLF. Methods: The PubMed, Cochrane Library, CNKI, and Embase databases were searched from their inception to March 2021 for reports on MSC therapy for HBV-ACLF. We used RevMan 5.3 to perform the systematic review and meta-analysis. Results: Four studies were ultimately included. Compared with the control treatment, allogeneic MSC treatment resulted in a higher cumulative survival rate among ACLF patients (OR=2.27; 95% CI 1.35, 3.81; p=0.002). The umbilical cord-derived MSC (UC-MSC) group obtained a higher survival rate than the control group (OR = 2.33; 95% CI 1.17, 4.63; p=0.02). The group with multiple interval peripheral vein injections of MSCs obtained a higher survival rate than the control group (OR = 2.09; 95% CI 1.20, 3.67; p=0.01). None of the adverse events were MSC-related. Conclusion: Our study indicates that MSC transplantation can significantly increase survival rates by improving liver function without severe adverse events. UC-MSCs harvested for allogeneic infusion via peripheral veins appear to provide superior treatment for patients.