1115 Does the Published Evidence Support Cell Transplantation in Liver Disease?
| Autor: | E Armstrong, E H Larkin |
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| Rok vydání: | 2021 |
| Předmět: | |
| Zdroj: | British Journal of Surgery. 108 |
| ISSN: | 1365-2168 0007-1323 |
| DOI: | 10.1093/bjs/znab259.962 |
| Popis: | Introduction Although a significant body of evidence proposes a role for cell transplantation as a bridge or alternative to orthotopic liver transplantation for a range of liver disorders, this therapy is not performed in the United Kingdom. Several cell types, including human hepatocytes and mesenchymal stem cells, have been assessed for safety and efficacy, with numerous transfusion protocols. In this review we critically evaluated published human studies of hepatocyte transplantation in respect of (i) methods used to evaluate efficacy of therapy, particularly the use of validated prognostic scores for liver disease (MELD or Child-Pugh), and (ii) discrepancies in patient outcomes between studies using different cell types and transfusion protocols. Method We reviewed 20 studies on cell transplantation as an alternative to orthotopic liver transplantation. Patient demographics, study design and outcome measures were compared. Outcome measures were post-cell transplant patient survival to (i) the end of the follow-up window, (ii) receipt of a liver transplant, or (iii) death. Results Inconsistencies found in study protocols included strategies for cell transfusion, post-transplant immunosuppression and follow-up interval and duration. Comparison of results was complicated by the outcome measures themselves, as neither receipt of a graft nor mortality can be represented in the prognostic scores used. Furthermore, many studies reported biochemistry data which could not be incorporated into MELD/Child-Pugh score format. Conclusions Meta-analysis of hepatocyte transplant studies is not possible on account of methodological inconsistencies and lack of large, controlled trials. These may be important factors preventing wider adoption of this intervention. |
| Databáze: | OpenAIRE |
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