Comparative Efficacy of Stem Cells on Chronic Decompensated Cirrhosis: A Network Meta-analysis

Currently, liver transplantation is the best way to improve the survival rate of decompensated cirrhosis, but its application is limited due to the shortage of donors and high cost. In the recent two decades, stem cell therapy is becoming a promising frontier alternative treatment. However, because various stem cell types, sources, and routes of administration can affect the therapeutic effect, we conducted this network meta-analysis to compare the efficacy of stem cells of different types, sources and delivery routes in the treatment of chronic decompensated cirrhosis. We retrieved the literature from PubMed, Embase, Cochrane Library, Web of Science from their establishment to December 2022. Additionally, clinicaltrials.gov was looked through for trials that had not yet been published or supplemental information that had been released as of December 2022. Only randomised controlled studies were included and patients must be aged at least 18 years and older with chronic decompensated liver cirrhosis but not acute-on-chronic liver failure. The included studies could be treated with stem cells of any source, type and route of administration. The primary outcome of measurement is the model of end-stage liver disease (MELD) score. This study has been registered with INPLASY (Registration number INPLASY202310050). From 2,374 articles, we included 18 studies with 936 patients. Our analysis showed no publication bias and revealed that human umbilical cord mesenchymal stem cells administered by artery and vein (hUCMSCsAV) can significantly improve MELD score of patients with chronic decompensated cirrhosis (SUCRA: 81.7%). Other effective stem cell approaches included ABMSCsA (SCURA: 65.7%), ABMSCsSH (SUCRA: 64.5%), ABMSCsGV (SUCRA: 63.5%), APBSCsGA (SUCRA: 58.7%), ABMNCsV (SUCRA: 54.9%), ABMSCsV (47.9%), and hUCMSCsV (46%). hUCMSCsAV was identified as the superior choice, followed by ABMSCsA. While these findings are promising, further high-quality research is necessary to confirm these results.