Granulocyte-colony stimulating factor for acute-on-chronic liver failure: systematic review and meta-analysis
Acute-on-chronic liver failure (ACLF) is associated with increased short and long-term mortality. Animal models of liver failure have demonstrated that granulocyte-colony stimulating factor (G-CSF) accelerates the liver regeneration process and improves survival. However, clinical evidence regarding...
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doaj-e771925fe4634f0b9f815a9422254c872021-06-09T05:52:02ZengElsevierAnnals of Hepatology1665-26812015-09-01145631641Granulocyte-colony stimulating factor for acute-on-chronic liver failure: systematic review and meta-analysisNorberto C. Chavez-Tapia0Indira Mendiola-Pastrana1Victoria J. Ornelas-Arroyo2Camilo Noreña-Herrera3Desiree Vidaña-Perez4Guadalupe Delgado-Sanchez5Misael Uribe6Tonatiuh Barrientos-Gutierrez, M.D., Ph.D.7Medica Sur Clinic & Foundation, Mexico City, MexicoNational Institute of Public Health. Cuernavaca, Mexico City, MexicoMedica Sur Clinic & Foundation, Mexico City, MexicoNational Institute of Public Health. Cuernavaca, Mexico City, MexicoNational Institute of Public Health. Cuernavaca, Mexico City, MexicoNational Institute of Public Health. Cuernavaca, Mexico City, MexicoMedica Sur Clinic & Foundation, Mexico City, MexicoNational Institute of Public Health. Cuernavaca, Mexico City, Mexico; Correspondence and reprint request:Acute-on-chronic liver failure (ACLF) is associated with increased short and long-term mortality. Animal models of liver failure have demonstrated that granulocyte-colony stimulating factor (G-CSF) accelerates the liver regeneration process and improves survival. However, clinical evidence regarding the use of G-CSF in ACLF remains scarce. The aim of this study was to assess the benefits and harms of G-CSF in patients with acute-on-chronic liver failure. An electronic search was made in The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS up to November 2013. Randomized clinical trials comparing the use of any regimen of G-CSF against placebo or no intervention in patients with ACLF were included. Primary outcomes included overal mortality, mortality due multi-organ failure, and adverse events. Relative risk (RR) and mean difference (MD) were used. Two trials involving 102 patients were included. A significant reduction in short-term overall mortality was observed in patients receiving G-CSF compared to controls (RR 0.56; 95%CI 0.39,0.80). G-CSF failed to reduce mortality secondary to gastrointestinal bleeding (RR 1.45; 95%CI 0.50, 4.27). Adverse effects reported included: fever, rash, herpes zoster, headache and nausea. In conclusion, the use of G-CSF for the treatment of patients with ACLF significantly reduced short-term mortality. While the evidence is still limited, the apparent benefit observed on short-term mortality, mild adverse effects and lack of an alternative therapy make the use of G-CSF in ACLF patients a reasonable alternative when liver transplantation is contraindicated or unavailable.http://www.sciencedirect.com/science/article/pii/S1665268119307574Hepatic insufficiencyEnd Stage Liver DiseaseFilgrastimLiver transplantationBone marrow cells |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Norberto C. Chavez-Tapia Indira Mendiola-Pastrana Victoria J. Ornelas-Arroyo Camilo Noreña-Herrera Desiree Vidaña-Perez Guadalupe Delgado-Sanchez Misael Uribe Tonatiuh Barrientos-Gutierrez, M.D., Ph.D. |
spellingShingle |
Norberto C. Chavez-Tapia Indira Mendiola-Pastrana Victoria J. Ornelas-Arroyo Camilo Noreña-Herrera Desiree Vidaña-Perez Guadalupe Delgado-Sanchez Misael Uribe Tonatiuh Barrientos-Gutierrez, M.D., Ph.D. Granulocyte-colony stimulating factor for acute-on-chronic liver failure: systematic review and meta-analysis Annals of Hepatology Hepatic insufficiency End Stage Liver Disease Filgrastim Liver transplantation Bone marrow cells |
author_facet |
Norberto C. Chavez-Tapia Indira Mendiola-Pastrana Victoria J. Ornelas-Arroyo Camilo Noreña-Herrera Desiree Vidaña-Perez Guadalupe Delgado-Sanchez Misael Uribe Tonatiuh Barrientos-Gutierrez, M.D., Ph.D. |
author_sort |
Norberto C. Chavez-Tapia |
title |
Granulocyte-colony stimulating factor for acute-on-chronic liver failure: systematic review and meta-analysis |
title_short |
Granulocyte-colony stimulating factor for acute-on-chronic liver failure: systematic review and meta-analysis |
title_full |
Granulocyte-colony stimulating factor for acute-on-chronic liver failure: systematic review and meta-analysis |
title_fullStr |
Granulocyte-colony stimulating factor for acute-on-chronic liver failure: systematic review and meta-analysis |
title_full_unstemmed |
Granulocyte-colony stimulating factor for acute-on-chronic liver failure: systematic review and meta-analysis |
title_sort |
granulocyte-colony stimulating factor for acute-on-chronic liver failure: systematic review and meta-analysis |
publisher |
Elsevier |
series |
Annals of Hepatology |
issn |
1665-2681 |
publishDate |
2015-09-01 |
description |
Acute-on-chronic liver failure (ACLF) is associated with increased short and long-term mortality. Animal models of liver failure have demonstrated that granulocyte-colony stimulating factor (G-CSF) accelerates the liver regeneration process and improves survival. However, clinical evidence regarding the use of G-CSF in ACLF remains scarce. The aim of this study was to assess the benefits and harms of G-CSF in patients with acute-on-chronic liver failure. An electronic search was made in The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS up to November 2013. Randomized clinical trials comparing the use of any regimen of G-CSF against placebo or no intervention in patients with ACLF were included. Primary outcomes included overal mortality, mortality due multi-organ failure, and adverse events. Relative risk (RR) and mean difference (MD) were used. Two trials involving 102 patients were included. A significant reduction in short-term overall mortality was observed in patients receiving G-CSF compared to controls (RR 0.56; 95%CI 0.39,0.80). G-CSF failed to reduce mortality secondary to gastrointestinal bleeding (RR 1.45; 95%CI 0.50, 4.27). Adverse effects reported included: fever, rash, herpes zoster, headache and nausea. In conclusion, the use of G-CSF for the treatment of patients with ACLF significantly reduced short-term mortality. While the evidence is still limited, the apparent benefit observed on short-term mortality, mild adverse effects and lack of an alternative therapy make the use of G-CSF in ACLF patients a reasonable alternative when liver transplantation is contraindicated or unavailable. |
topic |
Hepatic insufficiency End Stage Liver Disease Filgrastim Liver transplantation Bone marrow cells |
url |
http://www.sciencedirect.com/science/article/pii/S1665268119307574 |
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