Euroasian Journal of Hepato-Gastroenterology

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VOLUME 10 , ISSUE 2 ( July-December, 2020 ) > List of Articles

Original Article

Effect of Granulocyte Colony-stimulating Factor and Erythropoietin on Patients with Acute-on-chronic Liver Failure

Md Nazmul Haque, Mamun Al-Mahtab, Dulal C Das, Noor-E-Alam Sheikh Mohammad, Mamun Al Mahtab, Md Sakirul I Khan, Sheikh MF Akbar, Salimur Rahman

Keywords : Acute-on-chronic liver failure, Erythropoietin, Granulocyte colony-stimulating factor

Citation Information : Haque MN, Al-Mahtab M, Das DC, Mohammad NS, Al Mahtab M, Khan MS, Akbar SM, Rahman S. Effect of Granulocyte Colony-stimulating Factor and Erythropoietin on Patients with Acute-on-chronic Liver Failure. Euroasian J Hepatogastroenterol 2020; 10 (2):64-67.

DOI: 10.5005/jp-journals-10018-1330

License: CC BY-NC 4.0

Published Online: 06-01-2021

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Patients with acute-on-chronic liver failure (ACLF) have low survival without liver transplantation. Granulocyte colony-stimulating factor (G-CSF) improves survival in ACLF and erythropoietin (EPO) promotes hepatic regeneration in animal studies. The aim of this study is to determine whether coadministration of G-CSF and EPO improves the outcome in ACLF. Methods: The study was conducted in the Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka. Consecutive patients with ACLF were randomly assigned into group A and group B. Group A patients received subcutaneous G-CSF (5 mcg/kg/d) for 6 days and subcutaneous EPO (40 mcg/wk) for 4 weeks and group B patients received only standard medical care (control group). All patients were followed up for 3 months. The primary end point was to see survival at 3 months. Results: Patients had comparable baseline characteristics; hepatitis B virus infection was the commonest etiology of ACLF as both acute and chronic events. A higher proportion of patients were male in both groups. The survival was higher in group A than in group B at the end of 3 months (36.4% vs 29.4%; p = 0.457), but this was not statistically significant. Regarding complications, hepatorenal syndrome was higher in group B than in group A (36.7% vs 41.7%). In both the groups, Child–Turcotte–Pugh score and model for end-stage liver disease scores were similar before treatment and improved during follow-up. Conclusion: This is one of the early human studies that demonstrate potential hepatic regeneration using EPO in ACLF patients. Further study with a larger cohort will be needed to reproduce the results of the present work.


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