Posts tagged "acute-on-chronic liver failure"

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

May 4th, 2018 Posted by Journal Articles 0 comments on “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”

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.

Methods : 45 consecutive entecavir-treated HBV-ACLF patients were prospectively studied. Among these patients, 11 received both plasma exchange (PE) and a single transplantation of UCMSCs (group A), while 34 received only PE (group B). The primary endpoint was survival at 24 months.

Results : 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, PTand INR in group Awere 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.

Conclusion : UC-MSC transplantation is safe and effective for HBV-ACLF patients treated with PE and entecavir. It further improves the hepatic function and survival.

Springer Science+Business Media New York 2016

Stem Cell Rev and Rep  DOI 10.1007/s12015-016-9683-3

Title:  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.

Authors: Yu-Hua Li & Ying Xu & Hua-Mei Wu & Jing Yang & Li-Hong Yang & Wan Yue-Meng.

Allogeneic Bone Marrow–Derived Mesenchymal Stromal Cells for Hepatitis B Virus–Related Acute-on-Chronic Liver Failure: A Randomized Controlled Trial

February 5th, 2018 Posted by Journal Articles 0 comments on “Allogeneic Bone Marrow–Derived Mesenchymal Stromal Cells for Hepatitis B Virus–Related Acute-on-Chronic Liver Failure: A Randomized Controlled Trial”

Mortality from hepatitis B virus (HBV)–related acute-on-chronic liver failure (ACLF) is high due to limited treatment options. Preclinical and clinical investigations have proved that treatment with mesenchymal stromal cells (MSCs) is beneficial for recovery from liver injury.

We hypothesized that the outcome of HBV-related ACLF would be improved by MSC treatment. From 2010 to 2013, 110 patients with HBV-related ACLF were enrolled in this open-label, nonblinded randomized controlled study. The control group (n 5 54) was treated with standard medical therapy (SMT) only. The experimental group (n 5 56) was infused weekly for 4 weeks with 1.0 to 10 3 105 cells/kg allogeneic bone marrow–derived MSCs and then followed for 24 weeks. The cumulated survival rate of the MSC group was 73.2% (95% confidence interval 61.6%-84.8%) versus 55.6% (95% confidence interval 42.3%-68.9%) for the SMT group (P 5 0.03). There were no infusion-related side effects, but fever was more frequent in MSC compared to SMT patients during weeks 5-24 of follow-up. No carcinoma occurred in any trial patient in either group. Compared with the control group, allogeneic bone marrow–derived MSC treatment markedly improved clinical laboratory measurements, including serum total bilirubin and Model for End-Stage Liver Disease scores. The incidence of severe infection in the MSC group was much lower than that in the SMT group (16.1% versus 33.3%, P 5 0.04).

Mortality from multiple organ failure and severe infection was higher in the SMT group than in the MSC group (37.0% versus 17.9%, P 5 0.02). Conclusion: Peripheral infusion of allogeneic bone marrow–derived MSCs is safe and convenient for patients with HBV-related ACLF and significantly increases the 24-week survival rate by improving liver function and decreasing the incidence of severe infections.

Copyright © 2017 by the American Association for the Study of Liver Diseases.
View this article online at wileyonlinelibrary.com.  DOI 10.1002/hep.29189

HEPATOLOGY, VOL. 66, NO. 1, 2017

Title:  Allogeneic Bone Marrow–Derived Mesenchymal Stromal Cells for Hepatitis B Virus–Related Acute-on-Chronic Liver Failure: A Randomized Controlled Trial.

Authors:  Bing-liang Lin, Jun-feng Chen, Wei-hong Qiu, Ke-wei Wang, Dong-ying Xie, Xiao-yong Chen, Qiu-li Liu, Liang Peng, Jian-guo Li,
Yong-yu Mei, Wei-zhen Weng, Yan-wen Peng, Hui-juan Cao, Jun-qiang Xie, Shi-bin Xie, Andy Peng Xiang, and Zhi-liang Gao1, 
Andy Peng Xiang, and Zhi-liang Gao