Erschienen in:
24.08.2017 | Original Article
Therapeutic implications of granulocyte colony stimulating factor in patients with acute-on-chronic liver failure: increased survival and containment of liver damage
verfasst von:
Biplob Kumar Saha, Mamun Al Mahtab, Sheikh Mohammad Fazle Akbar, Sheikh Mohammad Noor-E-Alam, Ayub Al Mamun, Sharker Mohammad Shahadat Hossain, Mohammad Ashraful Alam, Ahmed Lutful Moben, Faiz Ahmad Khondaker, Forhadul Islam Chowdhury, Ruksana Raihan, Salimur Rahman, Ashok Kumar Choudhury, APASL ACLF working party
Erschienen in:
Hepatology International
|
Ausgabe 6/2017
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Abstract
Background and purpose
Mobilization of bone marrow-derived stem cells by granulocyte colony stimulating factor (G-CSF) supports hepatic regeneration and may augment clinical improvement in patients with acute-on-chronic liver failure (ACLF). The aim of this study is to assess the impact of G-CSF on complications and transplant-free survival in patients with ACLF.
Methods
Thirty-two patients with ACLF defined by Asian Pacific Association for the Study of the Liver (APASL) criteria were openly randomized to control (group A) or intervention (group B) receiving G-CSF (5 μg/kg/day, for 6 consecutive days) in addition to standard medical therapy with antiviral drugs. The patients were followed for 90 days.
Results
Simultaneous use of G-CSF and antiviral drugs in hepatitis B virus (HBV) ACLF significantly improved survival over antiviral drugs alone. Incidence of hepatorenal syndrome and hyponatremia were reduced due to use of G-CSF. Baseline parameters of the two groups of patients were comparable. Child–Turcotte–Pugh (CTP) and Model for End-Stage Liver Disease (MELD), disease severity scores improved in patients treated with G-CSF, with significant difference only for the CTP score at 90 days follow-up. In addition, mean white blood cell (WBC) count at day 15 was significantly higher in G-CSF group in absence of infection compared with control group.
Conclusions
G-CSF therapy improved survival and clinical recovery in HBV-ACLF. G-CSF therapy also prevented renal failure and hyponatremia. We strongly recommend use of G-CSF therapy in addition to standard medical therapy.