Granulocyte colony-stimulating factor with or without stem or progenitor cell or growth factors infusion for people with compensated or decompensated advanced chronic liver disease

Colli, Agostino; Fraquelli, Mirella; Prati, Daniele; Casazza, Giovanni

doi:10.1002/14651858.cd013532.pub2

Cited by 3 publications

(3 citation statements)

References 113 publications

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“…Nonetheless, these studies may have limitations, such as heterogeneity in patient populations and treatment protocols, and there are many methodological differences between those and our meta-analysis. A recent Cochrane review [22] also investigated the administration of G-CSF in patients with liver disease. However, the study examined data dichotomously and included patients with ACLF and decompensated and compensated liver cirrhosis, without focusing on ACLF.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the findings of this study, the recently published European guidelines [20] advise against the administration of G-CSF to patients with ACLF. Previous meta-analyses included patients with acute alcoholic hepatitis [21] and decompensated cirrhosis [22], which may have introduced bias into the data synthesis. The aim of this systematic review and meta-analysis is to comprehensively assess the available clinical data on the potential benefits of G-CSF therapy in patients with ACLF.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Granulocyte Colony-Stimulating Factor in Acute on Chronic Liver Failure: A Systematic Review and Survival Meta-Analysis

Konstantis,

Tsaousi,

Pourzitaki

et al. 2023

JCM

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Background: Acute-on-chronic liver failure (ACLF) mostly occurs when there is an acute insult to the liver in patients with pre-existing liver disease, and it is characterized by a high mortality rate. Various therapeutic approaches have been used thus far, with orthotopic liver transplantation being the only definitive cure. Clinical trials and meta-analyses have investigated the use of granulocyte colony-stimulating factor (G-CSF) to mobilize bone marrow-derived stem cells. Some studies have suggested that G-CSF may have a significant role in the management and survival of patients with ACLF. However, the results are conflicting, and the efficacy of G-CSF still needs to be confirmed. Aim: The aim was to assess the efficacy of G-CSF in patients with ACLF. Methods: Electronic databases were searched until May 2023 for randomized controlled trials investigating the use of G-CSF in adult patients with ACLF. Outcome measures were the effects of G-CSF on overall survival, changes in liver disease severity scores, complications of cirrhosis, other G-CSF-related adverse effects, and all-cause mortality. The study’s protocol has been registered with Prospero (CRD42023420273). Results: Five double-blind randomized controlled trials involving a total of 421 participants met the inclusion criteria. The use of G-CSF demonstrated a significant effect on overall survival (HR 0.63, 95% CI 0.41 to 0.95, and I2 48%), leading to a decreased mortality (LogOR-0.97, 95% CI −1.57 to −0.37, and I2 37.6%) and improved Model for End-Stage Liver Disease (MELD) scores (SMD −0.87, 95% CI −1.62 to −0.13, and I2 87.3%). There was no correlation between the improvement of the Child–Pugh score and the use of G-CSF(SMD −2.47, 95% CI −5.78 to 0.83, and I2 98.1%). The incidence of complications of cirrhosis did not decrease significantly with G-CSF treatment (rate ratio 0.51, 95% CI 0.26 to 1.01, and I2 90%). A qualitative synthesis showed that the use of G-CSF is safe. Conclusions: The administration of G-CSF has demonstrated a positive impact on overall survival, liver function, and the MELD score. The presence of heterogeneity in the included studies prohibits conclusive recommendations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy of Granulocyte Colony-Stimulating Factor in Acute on Chronic Liver Failure: A Systematic Review and Survival Meta-Analysis

Konstantis,

Tsaousi,

Pourzitaki

et al. 2023

JCM

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“…Studies by Garg et al [253] and Saha et al [254] have assessed the impact of G-CSF on patients with ACLF and have found that it prevented the development of HRS. However, a recent study by Colli et al [255] has shown that, while G-CSF therapy seemed to decrease mortality in patients with decompensated advanced chronic liver disease, it had no significant effect on the development of HRS, thus, since the evidence is uncertain, it is unknown whether stem cell therapy can be safely used to prevent HRS-AKI.…”

Section: Stem Cell Therapymentioning

confidence: 99%

Hepatorenal Syndrome—Novel Insights into Diagnostics and Treatment

Badura,

Frąk,

Hajdys

et al. 2023

IJMS

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Hepatorenal syndrome (HRS) is a disorder associated with cirrhosis and renal impairment, with portal hypertension as its major underlying cause. Moreover, HRS is the third most common cause of acute kidney injury, thus creating a major public health concern. This review summarizes the available information on the pathophysiological implications of HRS. We discuss pathogenesis associated with HRS. Mechanisms such as dysfunction of the circulatory system, bacterial infection, inflammation, impaired renal autoregulation, circulatory, and others, which have been identified as critical pathways for development of HRS, have become easier to diagnose in recent years. Additionally, relatively recently, renal dysfunction biomarkers have been found indicating renal injury, which are involved in the pathophysiology of HRS. This review also summarizes the available information on the management of HRS, focusing on vasoconstrictive drugs, renal replacement therapy, and liver transplant together with currently being investigated novel therapies. Analyzing new discoveries for the underlying causes of this condition assists the general research to improve understanding of the mechanism of pathophysiology and thus prevention of HRS.

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