Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2015; 21(28): 8697-8710
Published online Jul 28, 2015. doi: 10.3748/wjg.v21.i28.8697
Autologous bone marrow transplantation in decompensated liver: Systematic review and meta-analysis
Prasoon Pankaj, Qi Zhang, Xue-Li Bai, Ting-Bo Liang
Prasoon Pankaj, Qi Zhang, Xue-Li Bai, Ting-Bo Liang, Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Author contributions: Pankaj P and Zhang Q contributed equally to this work; Liang TB conceived the idea; Pankaj P and Bai XL performed the literature search; Pankaj P and Zhang Q extracted the data; Zhang Q analyzed the data; Pankaj P and Zhang Q drafted the manuscript; all authors approved the final version to be published.
Supported by National Natural Science Foundation of China (No. 81171884 and No. 81401954) and Innovation and High-Level Talent Training Program of the Department of Health of Zhejiang Province, China.
Conflict-of-interest statement: The authors declare there to be no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ting-Bo Liang, MD, PhD, Professor, Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China. liangtingbo@zju.edu.cn
Telephone: +86-571-87315005 Fax: +86-571-87315005
Received: November 2, 2014
Peer-review started: November 3, 2014
First decision: March 10, 2015
Revised: March 27, 2015
Accepted: April 28, 2015
Article in press: April 28, 2015
Published online: July 28, 2015
Abstract

AIM: To evaluate the efficacy of autologous bone marrow mononuclear cell transplantation in decompensated liver disease.

METHODS: Medline, EMBASE, PubMed, Science Direct, and the Cochrane Library were searched for relevant studies. Retrospective case-control studies were included along with randomized clinical trials. Meta-analysis was performed in line with recommendations from the Cochrane Collaboration software review manager. Heterogeneity was assessed using a random-effects model.

RESULTS: Four randomized controlled trials and four retrospective studies were included. Cell transplantation increased serum albumin level by 1.96 g/L (95%CI: 0.74-3.17; P = 0.002], 2.55 g/L (95%CI: 0.32-4.79; P = 0.03), and 3.65 g/L (95%CI: 0.76-6.54; P = 0.01) after 1, 3, and 6 mo, respectively. Patients who had undergone cell transplantation also had a lower level of total bilirubin [mean difference (MD): -1.37 mg/dL; 95%CI: -2.68-(-0.06); P = 0.04] after 6 mo. This decreased after 1 year when compared to standard treatment (MD: -1.26; 95%CI: -2.48-(-0.03); P = 0.04]. A temporary decrease in alanine transaminase and aspartate transaminase were significant in the cell transplantation group. However, after 6 mo treatment, patients who had undergone cell transplantation had a slightly longer prothrombin time (MD: 5.66 s, 95%CI: 0.04-11.28; P = 0.05). Changes in the model for end-stage liver disease score and Child-Pugh score were not statistically significant.

CONCLUSION: Autologous bone marrow transplantation showed some benefits in patients with decompensated liver disease. However, further studies are still needed to verify its role in clinical treatment for end-stage liver disease.

Keywords: Autologous transplantation, Bone marrow, Cirrhosis, Decompensated liver disease

Core tip: Autologous bone marrow mononuclear cells prevent immune rejection. In this systematic review and meta-analysis, we attempted to gather evidence for the therapeutic use of autologous bone marrow mononuclear cell transplantation for decompensated liver disease and cirrhosis. Although we found that autologous bone marrow transplantation is satisfactory in patients with decompensated liver disease, there are important issues that require verification by large-volume centers.