P3847 - Role of Granulocyte Colony Stimulating Factor Therapy in Decompensated Liver Cirrhosis: A Meta-Analysis

Reem Dimachkie, MD, Rachelle Hamadi, MD, Zakaria Alameddine, MD, Hussam Aridi, MD, Samer Asmar, MD, Liliane Deeb, MD
Staten Island University Hospital, Staten Island, NY

Introduction: Decompensated liver cirrhosis has a high 5‐year mortality rate reaching up to 80%. Liver transplantation is the ultimate treatment, but due to organ shortage and multiple contraindications, a search for non-surgical treatments is ongoing in the hope to improve transplant-free survival. G-CSF (Granulocyte-colony stimulating factor) has been shown to exhibit regenerative and immunomodulatory properties by enhancing mobilization of bone marrow-derived stem cells, making it a potential promising treatment in end stage liver disease. However, the literature is controversial regarding patient selection and outcomes of use of G-CSF in decompensated cirrhosis. Therefore we conducted a meta-analysis of randomized controlled trials (RCTs) to compare the survival benefit between patients with decompensated cirrhosis treated with G-CSF and standard medical therapy (SMT) versus SMT alone.

Methods: A literature search was performed in four databases from data inception up to December 2022, and all registered randomized controlled (RCTs) evaluating G-CSF-based therapies for cirrhotic patients were included.



Results: The study combined the results of four published RCTs and included a total of 297 patients who received G-CSF plus SMT and 298 patients who received SMT alone. Using a random model effect, the overall results indicate that G-CSF+SMT is associated with higher odds of survival compared to SMT alone, with a risk ratio of 1.28 (95% CI [1.08, 1.5]), which is statistically significant (Z = 2.92, P = 0.003). Heterogeneity existed among the individual studies, as revealed by the Chi² test (Chi² = 5.28, df = 3, P = 0.16) and the I² statistic (I² = 43%), but overall, G-CSF showed potential in improving survival. The G-CSF+SMT treatment demonstrated an improvement in the Child-Pugh-Turcotte (CTP) score, with a pooled mean difference estimate of -2.51 (CI -4.33 to -0.70), I² = 0%, and a Z-value of 2.72 (P = 0.007). Additionally, there was a significant increase in the CD34 level at the end of the intervention (day 6) for the G-CSF+SMT group (Z = 4.76, P < 0.00001). Although the MELD score showed improvement, the difference between the two groups did not reach statistical significance.



Discussion: These results suggest that the combination of G-CSF and SMT may have a positive impact on the survival rate and improvement in CTP score in patients with DC. Further RCTs are needed to shed more light on this promising modality in end stage liver disease.





Disclosures:


Reem Dimachkie, MD, Rachelle Hamadi, MD, Zakaria Alameddine, MD, Hussam Aridi, MD, Samer Asmar, MD, Liliane Deeb, MD. P3847 - Role of Granulocyte Colony Stimulating Factor Therapy in Decompensated Liver Cirrhosis: A Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.