Abstracto
Fondo
Stem cell therapy is becoming an emerging therapeutic option for chronic liver disease (CLD). Sin embargo, whether stem cell therapy is more effective than conventional treatment remains questionable. We performed a large-scale meta-analysis of randomized controlled trials (ECA) to evaluate the therapeutic effects and safety of stem cell therapy for CLD.
Métodos
We systematically searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov databases for the period from inception through March 16, 2020. Primary outcomes were all-cause mortality and adverse events related to stem cell therapy. Secondary outcomes included the model for end-stage liver disease score, total bilirubin, albúmina, alanine aminotransferase, prothrombin activity, y ratio normalizado internacional. The standardized mean difference (SMD) and odds ratio (O) con 95% intervalo de confianza (CI) were calculated using a random-effects model.
Resultados
Twenty-four RCTs were included and the majority of these studies showed a high risk of bias. The meta-analysis indicated that compared with conventional treatment, stem cell therapy was associated with improved survival and liver function including the model of end-stage liver disease score, total bilirubin, and albumin levels. Sin embargo, it had no obvious beneficial effects on alanine aminotransferase level, prothrombin activity, y ratio normalizado internacional. Subgroup analyses showed stem cell therapy conferred a short-term survival benefit for patients with acute-on-chronic liver failure (ACLF), a single injection was more effective than multiple injections, hepatic arterial infusion was more effective than intravenous infusion, and bone marrow-derived stem cells were more effective than those derived from the umbilical cord. Thirteen trials reported adverse events related to stem cell therapy, but no serious adverse events were reported.
Conclusions
Stem cell therapy is a safe and effective therapeutic option for CLD, while patients with ACLF benefit the most in terms of improved short-term survival. A single injection administration of bone marrow-derived stem cells via the hepatic artery has superior therapeutic effects.
Interesado en saber si los programas clínicos actuales, desarrollos de investigacion, o enfoques terapéuticos emergentes pueden ser relevantes para su situación?
Información educativa y de investigación únicamente.. Las decisiones médicas individuales deben tomarse en consulta con profesionales sanitarios cualificados..
