THE USE OF GRANULOCYTE-COLONY-STIMULATING FACTOR AFTER LIVER-TRANSPLANTATION

Granulocyte colony-stimulating factor (G-CSF) increases the number of circulating granulocytes and decreases TNF production while improving survival in sepsis models. To study the effects of G-CSF administratio n on sepsis and rejection, 37 primary liver allograft recipients recei ved intravenous recombinant human G-CSF (rhG-CSF; 5-10 mu g/kg/day) fo r the first 7-10 days following transplantation, targeting a blood abs olute granulocyte count of between 10,000 and 20,000 cells/mm(3). Thes e recipients were monitored prospectively for sepsis and rejection, as were the previous 49 primary liver allograft recipients who did not r eceive G-CSP. Both groups utilized identical protocol immunosuppressio n and standardized diagnosis and treatment of sepsis and rejection. Un ivariate and logistic regression analysis of risk factors for sepsis a nd rejection revealed no difference between the two patient groups. G- CSF-treated patients developed an increased absolute granulocyte count over time (P<0.0001, repeated-measures analysis of variance). G-CSF-t reated patients had a decreased number of sepsis episodes per patient (0.92+/-1.5 vs. 2.18+/-2.8, P<0.02, t test), and a lower percentage of sepsis-related deaths (8% vs. 22%, P<0.04, chi-square test). The inci dence of acute rejection was decreased in the G-CSF-treated group (22% vs. 51%, P<0.01, chi-square test). These pilot data support further i nvestigation into G-CSF's favorable effects on sepsis and rejection.