Online Aspen Webinar (Part 9) -Liver Disease After Fontan, Acute on Chronic Liver Disease and Immunosuppression Withdrawal Strategies

Below I’ve included a few more slides form recent Aspen Webinars

Fontan Associated Liver Disease  Greg Tiao

Related blog posts:

Acute on Chronic Liver Failure  Estella Alonso

Immunosuppression strategies ..and is withdrawal possible  Kathleen Campbell

GCSF for acute-on-chronic liver failure

When chronic liver patients decompensate, there are a number of considerations, including concerns about spontaneous bacterial peritonitis, GI bleeding, and renal insufficiency.  A new study looks at another treatment to improve the outcome of these patients.  Consecutive patients with acute-on-chronic liver failure (ACLF) were randomly assigned to granulocyte colony-stimulating factor (GCSF) therapy (n=23), 5 μg/kg subcutaneously, or placebo (n=24) (Gastroenterology 2012; 142: 505-12).

The average age in this study was 40 years with the most common etiology being liver disease related to alcohol. The GCSF group, treated with 12 doses over 1 month, had higher leukocyte and platelet counts at 1 week.  More importantly, at day 60, the GCSF had higher survival, 70% vs 29%.  In addition, therapy was associated with lower Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD) and sequential organ failure assessment (SOFA) scores.

GCSF has been shown to improve results in animal models and has been used in chronic liver disease.  The mechanism for improvement following GCSF is not clear.  One role could be in the prevention of sepsis due to increased neutrophils; patients on GCSF had less multi-organ failure which is often precipitated by sepsis.  Another factor could be an element of hepatic regeneration induced by GCSF.  It was noted that CD34 cell population increased in the liver tissue after 4 weeks of GCSF protocol.

Additional reference:

  • -Dig Liver Dis 2007; 39: 1071-76.  Use of GCSF for 5 days was not effective for acute -on-liver disease