Human stem cells for decompensated cirrhosis in adults

Area of Science:

• Hepatology
• Regenerative Medicine
• Clinical Trials

Background:

• Liver cirrhosis is a leading cause of death, with limited treatment options beyond transplantation.
• Human stem cell interventions offer potential for liver tissue regeneration and function maintenance in decompensated cirrhosis.
• Current randomized clinical trial results for stem cell therapy in decompensated cirrhosis are inconsistent.

Purpose of the Study:

• To assess the benefits and harms of human stem cell interventions in adults with decompensated cirrhosis.
• To evaluate various stem cell types, administration routes, and dosages.
• To synthesize evidence on critical outcomes like mortality, adverse events, and quality of life.

Main Methods:

• Systematic search of multiple databases and trial registers up to October 2024.
• Inclusion of randomized clinical trials comparing any stem cell type versus placebo or conventional treatment.
• Assessment of risk of bias using the RoB 2 tool and meta-analysis using random-effects models.

Main Results:

• Twelve trials with 823 adults were included, assessing various human stem cell types.
• All evidence was assessed as very low certainty due to risk of bias, inconsistency, and imprecision.
• Uncertainty exists regarding stem cell effects on all-cause mortality, serious adverse events, quality of life, complications, non-serious adverse events, and liver function.

Conclusions:

• The effects of human stem cell therapy for decompensated cirrhosis remain uncertain due to very low-certainty evidence.
• Insufficient high-quality randomized clinical trials with adequate outcome data hinder definitive conclusions.
• Ongoing trials may provide crucial insights if well-designed and conducted.