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Granulocyte-Colony Stimulating Factor Mobilizes CD34+ Cells and improves Survival of Patients with Acute-On-Chronic Liver Failure.
MedLine Citation:
PMID:  22119930     Owner:  NLM     Status:  Publisher    
BACKGROUND & AIMS: Acute-on-chronic liver failure (ACLF) develops in patients with chronic liver disease and has high mortality. Mobilization of bone marrow-derived stem cells with granulocyte-colony stimulating factor (G-CSF) could promote hepatic regeneration. METHODS: Consecutive patients with ACLF were randomly assigned to groups given 5 µg/kg subcutaneous G-CSF (12 doses; Group A, n=23) or placebo (Group B, n=24) plus standard medical therapy. We assessed survival until day 60; Child Turcotte Pugh (CTP), model for end-stage liver disease (MELD), and sequential organ failure assessment (SOFA) scores; and the development of other related complications. RESULTS: After 1 week of treatment, group A had higher median leukocyte and neutrophil counts than group B (P <.001). Sixteen patients in group A (69.6%) and 7 in group B (29%) survived; the actuarial probability of survival at day 60 was 66% vs 26%, respectively (P =.001). G-CSF also reduced CTP scores in group A (by a median of 33.3%, compared with an increase of 7.1% in group B (P =.001), along with MELD (median reduction of 15.3%, compared with an increase of 11.7% in group B; P =.008) and SOFA scores (median reduction of 50%, compared with an increase of 50% in group P (P =.001). The percentages of patients that developed hepatorenal syndrome, hepatic encephalopathy, or sepsis were lower in group A than B (19% vs 71%; P =.0002), (19% vs 66%; P =.001), and (14% vs 41%; P =.04)] respectively. After 1 month of treatment, G-CSF increased the number of CD34+ cells in the liver (by 45%, compared with 27.5% in group B; P =.01). CONCLUSIONS: G-CSF therapy more than doubles the percentage of patients with ACLF that survive for 2 months; it significantly reduces CTP, MELD, and SOFA scores and prevents development of sepsis, HRS, and hepatic encephalopathy.
Vishal Garg; Hitendra Garg; Arshi Khan; Nirupama Trehanpati; Ashish Kumar; Barjesh Chander Sharma; Puja Sakhuja; Shiv Kumar Sarin
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-11-22
Journal Detail:
Title:  Gastroenterology     Volume:  -     ISSN:  1528-0012     ISO Abbreviation:  -     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.
Department of Gastroenterology, GB Pant Hospital, New Delhi, India.
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