Published online Mar 31, 2020. doi: 10.5500/wjt.v10.i3.64
Peer-review started: December 4, 2019
First decision: December 12, 2019
Revised: February 10, 2020
Accepted: March 23, 2020
Article in press: March 23, 2020
Published online: March 31, 2020
Orthotopic liver transplantation (OLT) is the only treatment for end-stage liver failure; however, the shortage of donor organs limits its application. To overcome this problem, many researchers have attempted to develop alternatives to OLT.
There are several reports of alternative therapies. Nevertheless, no study has comprehensively analyzed these therapies from varying perspectives.
This systematic review aims to summarize the current status of alternative transplantation therapies for OLT and to support future research.
A systematic review was performed by searching the PubMed, Cochrane Library and EMBASE databases for studies concerning alternative transplantation therapy for OLT. We used the following MeSH terms: “liver transplantation”, “cell”, “differentiation”, “organoid”, and “xenotransplantation”. Various types of studies were retrieved for full-text evaluation. Of these, we selected articles involving in vivo transplantation.
A total of 89 studies were selected. There are three principle forms of treatment: Xeno-organ transplantation (14 articles), scaffold-based transplantation (22 articles), and cell transplantation (53 articles). Various types of sources for transplantation were discussed: Organ liver, 25 articles; adult hepatocytes, 31 articles; mesenchymal stem cells (MSCs), 25 articles; induced pluripotent stem cells, three articles and other sources. Clinical applications were discussed only for cell transplantation (12 studies; four studies using hepatocytes, five studies using umbilical cord-derived MSCs, three studies using bone marrow-derived MSCs, and two studies using hematopoietic stem cells).
This systematic review summarized alternative therapies for OLT from varying perspectives. Alternative therapies have been deeply researched, particularly xeno-organ, scaffold-based, and cell transplantation. Clinically, only cell transplantation with hepatocytes and MSCs have been applied. Scaffold-based transplantation is a comprehensive treatment that combines xeno-organ and cell transplantations. Future research on the clinical application of scaffold-based transplantation is expected.
This systematic review describes the current status of alternative therapy for OLT in end-stage liver failure. Further studies are needed for clinical applications in the future.