SINGLE DOSE OF G-CSF IN LEUKOPENIA AFTER POST LIVER TRANSPLANT

Abstract

Immunosuppressive therapies are the main treatment modalities after transplantation to prevent rejection. One of the major side effects of potent immunosuppressant is Leukopenia. Granulocyte colony stimulating factor (G-CSF) is a cytokine agent which is increasing life span and functional activity of mature neutrophils. G-CSF is a well-established treatment of chemotherapy induced Leukopenia, during hematopoietic stem cell transplantation and HIV infection neutropenia. There were several studies in animal models of liver diseases which showed hematopoietic stem cell mobilization into the injured liver and their differentiation to hepatocytes. There were a few clinical trials in human after development of neutropenia in post Liver transplantation (LTx) periods. This study was designed as a pilot study to evaluate the safety of G-CSF on Leukopenia in early post LTx periods. Seventeen Leukopenic patients in 4 weeks after LTx entered to the study and randomized in one to one manner in this open label study. Treatment group received 0.3 mg of GCSF (PD- G-CSF) at the time of Leukopenia (≤3000/mm³) and Short term patient's and graft survival were determined. Data are reported as mean and all date were analyzed using chi square and Student t-test. (SPSS of ware, version 14) P values< 0.05 were considered significant. Nine patients in control group and 8 patients recruited in the treatment group. There were no significant differences in days of hospital admission (P: 0.244), microbiologic active Cultures (P: 0.30), Oropharyngial candidiasis (P: 0.30), acute cellular rejection (ACR) (P: 0.437) and day of desirable Mycofenolate Mofetile (MMF) dosage achievement (P: 0.691) and episodes of ACR treatments (P: 0.08). Our open labeled pilot study showsthat single dose of G-CSF in leukopenic post liver transplant patients is safe. Although there was no statistically significant beneficial effect on hospital stay, opportunistic and surgical site infections but there was a trend toward less ACR episodes in the treatment group. Whether single dosage has a beneficial effect on liver function, survival, rejection and hospital stay needs further research in another clinical trial.

Keywords:G-CSF, Leukopenia, Post Liver Transplant