Objectives Neutrophil function is defective in acute liver failure (ALF) an
d the in vitro ability of granulocyte colony-stimulating factor (G-CSF) to
reverse these defects has been reported. The effects of administering G-CSF
to ALF patients are presented in this study.
Design This was a prospective, phase I/II, open label, study.
Setting The liver intensive therapy unit at King's College Hospital, London
.
Participants Sequential patients admitted with acute liver failure due to a
cetaminophen overdose.
Interventions G-CSF was given to four groups (each n = 6) of ALF patients a
s a daily infusion at 25, 50, 100 or 150 mug/m(2). A control group of eight
patients did not receive G-CSF.
Main outcome measures Neutrophil phagocytosis and killing of Staphylococcus
aureus and superoxide release before G-CSF administration and at 24 and 96
h thereafter.
Results Neutrophils from patients receiving 50, 100 or 150 mug/m(2) G-CSF,
but not from control patients or those receiving 25 mug/m(2), showed signif
icantly increased phagocytosis and killing at 96 h, Doses of 50 or 150 mug/
m(2) G-CSF resulted in increased superoxide production at 96 h. No patients
discontinued treatment as a consequence of side effects related to G-CSF a
dministration.
Conclusions G-CSF administration is a safe and effective means of reversing
the neutrophil defects of ALF, and may have a role in the prevention and t
reatment of infection in these patients. A dose of 50 mug/m(2)/day is as ef
fective as higher doses and was associated with fewer side effects. Eur J G
astroenterol Hepatol 12:1323-1328 (C) 2000 Lippincott Williams & Wilkins.