Improving survival in ACLF: growing evidence for use of G-CSF

Excerpt

Acute-on-chronic liver failure (ACLF) has recently been proposed as an alternate route in the natural history of patients with chronic liver disease, and is associated with extremely high mortality. ACLF is characterized by acute hepatic decompensation in a patient with previously diagnosed or undiagnosed chronic liver disease [1] and failure of one or more extrahepatic organ [2]. Currently, there are no specific therapies for ACLF; management focuses on addressing the precipitant factor and supportive care. Liver transplantation is the ultimate treatment for those who are acceptable candidates, but is limited by organ shortage and high frequency of contraindications in this group of patients. Granulocyte-colony stimulating factor (G-CSF) has recently been proposed as a candidate ACLF treatment. G-CSF promotes mobilization of hematopoietic stem cells and proliferation of hepatic progenitor cells in animal models of liver failure [3] as well as in patients with alcoholic hepatitis, a common form of ACLF in the Western world [4]. A few small randomized clinical trials have demonstrated not only improvement in liver function with G-CSF but also significant survival benefit compared with standard medical therapy for ACLF [5‐8]. However, additional randomized trials in different populations are needed to corroborate these findings before widespread use of G-CSF can be advocated worldwide. …