Therapeutic implications of granulocyte colony stimulating factor in patients with acute-on-chronic liver failure: increased survival and containment of liver damage

• DOI: 10.1007/s12072-017-9814-1
• Publication Date: 2017-08-24T11:55:06Z
• Authors: Biplob Kumar Saha; Mamun Al Mahtab; Sheikh Mohammad F...; Sheikh Mohammad N...; Ayub Al Mamun; Sharker Mohammad ...; Mohammad Ashraful...; Ahmed Lutful Moben; Faiz Ahmad Khondaker; Forhadul Islam Ch...; Ruksana Raihan; Salimur Rahman; Ashok Kumar Choud...
• Keywords: Adult; Male; Hepatorenal Syndrome; Adolescent; Acute-On-Chronic Liver Failure; Middle Aged; Antiviral Agents; Severity of Illness Index; 3. Good health; Survival Rate; Leukocyte Count; Young Adult; 03 medical and health sciences; Hepatitis B, Chronic; 0302 clinical medicine; Granulocyte Colony-Stimulating Factor; Humans; Drug Therapy, Combination; Female; Prospective Studies; Hyponatremia

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.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.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.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.