Mesenchymal stem cells for refractory acute respiratory distress syndrome after liver transplantation

doi:10.3877/cma.j.issn.2095-3232.2020.03.008

Abstract

Abstract:

Objective

To evaluate the safety and efficacy of human umbilical mesenchymal stem cells (HUMSCs) in the treatment of refractory acute respiratory distress syndrome (ARDS) after liver transplantation.

Methods

Clinical data of 10 patients with refractory moderate to severe ARDS undergoing salvage HUMSCs therapy in the Third Affiliated Hospital of Sun Yat-senUniversity from December 3, 2015 to December 20, 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 8 patients were male and 2 female, aged 23-69 years with a median age of 48 years. The safety of HUMSCs treatment was observed. The changes of oxygenation index, lung injury score and radiological assessment of lung edema (RALE) before and after HUMSCs treatment were statistically compared. After HUMSCs treatment, the parameter changes were analyzed by single-factor repeated measurement analysis of variance and Bonferroni method.

Results

No adverse events related to HUMSCs infusion were observed. Compared with the average oxygenation index of (109±29) mmHg (1 mmHg=0.133 kPa) before HUMSCs infusion, the oxygenation index at 1 d after HUMSCs infusion was significantly elevated to (235±132) mmHg (t=3.00, P<0.017). Compared with the lung injury score of 2.9±0.6 before HUMSCs infusion, the lung injury score was significantly declined to 1.8±0.9 at 3 d after HUMSCs infusion (t=-4.00, P<0.017). Compared with the RALE score of 33±5 before infusion, the RALE score was significantly decreased to 27±7 at 7 d after infusion (t=-4.40, P<0.017). 6 patients with refractory moderate ARDS underwent liver transplantation, and 4 of them were successfully extubated after oxygenation index was improved within 1 week. The remaining 2 patients with moderate ARDS and4 patients with severe refractory ARDS died of primary disease progression.

Conclusions

HUMSCs infusion is a feasible and safe treatment for refractory ARDS after liver transplantation, which can significantly mitigate the lung injury.

Key words: Mesenchymal stem cells, Liver transplantation, Respiratory distress syndrome, adult

Jun Guo, Xiaomeng Yi, Yuling An, Xuxia Wei, Mingming Fan, Lijuan Li, Pinglan Lu, Huimin Yi, Haijin Lyu. Mesenchymal stem cells for refractory acute respiratory distress syndrome after liver transplantation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2020, 09(03): 232-238.

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References 24

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