New directions for cell-based therapies in acute liver failure

The mortality in acute liver failure (ALF) remains high despite superior contemporary management. Although orthotopic liver transplantation (OLT) is best for rescue in ALF, donor organ shortages and contraindications or irreversible neurological complications may restrict OLT. Therefore, alternative therapeutic approaches for ALF are necessary. These are typically aimed at managing complications, ameliorating inflammation, providing hepatic support, and inducing liver repair/regeneration. Whether cell therapy would offer such benefits is of interest for many reasons: cells from one donor could be used for several people; cryopreserved and banked cells could be administered rapidly; cells could be transplanted multiple times; provision of hepatic support from transplanted cells could “bridge” to OLT; reseeding of the liver with transplanted cells could promote tissue repair; secretion of appropriate factors from transplanted cells could aid liver regeneration, which might avoid OLT altogether; cell therapy is technically simple and is also “reversible” because the native liver need not be removed.