3 results on '"Liver Regeneration drug effects"'
Search Results
2. Combination of granulocyte colony-stimulating factor and erythropoietin improves outcomes of patients with decompensated cirrhosis.
- Author
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Kedarisetty CK, Anand L, Bhardwaj A, Bhadoria AS, Kumar G, Vyas AK, David P, Trehanpati N, Rastogi A, Bihari C, Maiwall R, Garg HK, Vashishtha C, Kumar M, Bhatia V, and Sarin SK
- Subjects
- Adult, Biopsy, Darbepoetin alfa, Disease Progression, Double-Blind Method, Drug Administration Schedule, Drug Therapy, Combination, Erythropoietin administration & dosage, Erythropoietin adverse effects, Female, Granulocyte Colony-Stimulating Factor adverse effects, Humans, India, Injections, Subcutaneous, Kaplan-Meier Estimate, Liver pathology, Liver physiopathology, Liver Cirrhosis diagnosis, Liver Cirrhosis etiology, Liver Cirrhosis mortality, Liver Cirrhosis physiopathology, Liver Regeneration drug effects, Male, Middle Aged, Paracentesis, Proportional Hazards Models, Prospective Studies, Risk Factors, Severity of Illness Index, Shock, Septic etiology, Shock, Septic prevention & control, Time Factors, Treatment Outcome, Erythropoietin analogs & derivatives, Granulocyte Colony-Stimulating Factor administration & dosage, Liver drug effects, Liver Cirrhosis drug therapy
- Abstract
Background & Aims: Patients with decompensated cirrhosis have significantly reduced survival without liver transplantation. Granulocyte colony-stimulating factor (G-CSF) has been shown to increase survival in patients with acute-on-chronic liver failure, and erythropoietin promoted hepatic regeneration in animal studies. We performed a double-blind, randomized, placebo-controlled trial to determine whether co-administration of these growth factors improved outcomes for patients with advanced cirrhosis., Methods: In a prospective study, consecutive patients with decompensated cirrhosis seen at the Institute of Liver and Biliary Sciences, New Delhi (from May 2011 through June 2012) were randomly assigned to groups given subcutaneous G-CSF (5 μg/kg/d) for 5 days and then every third day (12 total doses), along with subcutaneous darbopoietin α(40 mcg/wk) for 4 weeks (GDP group, n = 29), or only placebos (control group, n = 26). All patients also received standard medical therapy and were followed for 12 months. Histology was performed on liver biopsies. The primary end point was survival at 12 months., Results: Baseline characteristics of patients were comparable; alcohol intake was the most common etiology of cirrhosis. A higher proportion of patients in the GDP group than controls survived until 12 months (68.6% vs 26.9%; P = .003). At 12 months, Child-Turcotte Pugh scores were reduced by 48.6% in the GDP group and 39.1% in the control group, from baseline (P = .001); Model for End Stage Liver Disease scores were reduced by 40.4% and 33%, respectively (P = .03). The need for large-volume paracentesis was significantly reduced in GDP group, compared with controls (P < .05). A lower proportion of patients in the GDP group developed septic shock (6.9%) during follow-up compared with controls (38.5%; P = .005). No major adverse events were observed in either group., Conclusions: In a single-center randomized trial, a significantly larger proportion of patients with decompensated cirrhosis given a combination of G-CSF and darbopoietin α survived for 12 months more than patients given only placebo. The combination therapy also reduced liver severity scores and sepsis to a greater extent than placebo. Clinicaltrials.gov ID: NCT01384565., (Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
3. Granulocyte colony-stimulating factor mobilizes CD34(+) cells and improves survival of patients with acute-on-chronic liver failure.
- Author
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Garg V, Garg H, Khan A, Trehanpati N, Kumar A, Sharma BC, Sakhuja P, and Sarin SK
- Subjects
- Adult, Aged, Chi-Square Distribution, End Stage Liver Disease diagnosis, End Stage Liver Disease immunology, End Stage Liver Disease mortality, Female, Granulocyte Colony-Stimulating Factor adverse effects, Humans, India, Kaplan-Meier Estimate, Liver immunology, Liver pathology, Liver Failure, Acute diagnosis, Liver Failure, Acute immunology, Liver Failure, Acute mortality, Liver Regeneration drug effects, Male, Middle Aged, Severity of Illness Index, Stem Cells immunology, Stem Cells pathology, Survival Rate, Time Factors, Treatment Outcome, Young Adult, Antigens, CD34 metabolism, Cell Movement drug effects, End Stage Liver Disease drug therapy, Granulocyte Colony-Stimulating Factor therapeutic use, Liver drug effects, Liver Failure, Acute drug therapy, Stem Cells drug effects
- Abstract
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 G-CSF subcutaneously (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% versus 26%, respectively (P = .001). Treatment with 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 B; P = .001). The percentages of patients who developed hepatorenal syndrome, hepatic encephalopathy, or sepsis were lower in group A than in group 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 who survive for 2 months; it also significantly reduces CTP, MELD, and SOFA scores and prevents the development of sepsis, hepatorenal syndrome, and hepatic encephalopathy., (Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.)
- Published
- 2012
- Full Text
- View/download PDF
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