Doctorate student of Medical Sciences Faculty of Medicine, Universitas Indonesia (FK UI), dr. Tri Hening Rahayatri, Sp.B, SubspPed(K), investigated the role of Granulocyte-Colony Stimulating Factor (G-CSF) as a linking therapy to improve the clinical condition of pediatric cirrhotic patients.
Liver cirrhosis is a condition where the liver is filled with scar tissue due to prolonged liver damage. Malnutrition and infection are frequent complications experienced by pediatric liver cirrhosis patients while undergoing preparation for liver transplantation.
These complications lead to worsening of the condition and increase the risk of death. In his dissertation entitled “The Role of Granulocyte-Colony Stimulating Factor (G-CSF) for Improving Pediatric End-Stage Liver Disease (PELD) Score and Pretransplant Liver Nutrition Status in Child Liver Cirrhosis through Immunomodulation of Neutrophils, CD34+ Cells, TNF-, HGF, and IL-10”, Tri looked at the role of G-CSF in liver cirrhosis patients in children aged 3 months to 12 years.
Previously, G-CSF was used as a treatment for acute and chronic liver failure in adults. One study stated that giving G-CSF promising clinical improvement, while another study assessed that G-CSF did not give good results in liver failure.
Meanwhile, there have been no studies on the use of G-CSF in pediatric liver cirrhosis patients. Research conducted by dr. Tri Hening was carried out in a span of 3 months for 50 patients.
These patients were divided into two groups, namely the treatment group (G-CSF therapy, 26 subjects) and the control group (24 subjects). Based on the results of the study, the administration of G-CSF therapy did not show any improvement in PELD scores within 3 months.
The nutritional status of the patient has also not been improved by the administration of G-CSF therapy. However, the administration of G-CSF improves the immune system of pediatric liver cirrhosis patients through an increase in white blood cells that play a role in the inflammatory process.
“G-CSF is able to mobilize blood stem cells (hematopoietic) so that the initial process of liver cell repair occurs which is marked by a special marker CD34+. Immune system disorders caused by liver cirrhosis have been shown to improve with increased levels of pro-inflammatory cytokines, pro-inflammatory cytokines (TNF-?), and decreased anti-inflammatory cytokines (IL-10),” said Tri, a lecturer at the Medical Faculty of Surgery. This UI, Saturday, August 13, 2022.
Improvement of the immune system is characterized by a reduction in the incidence of severe inflammatory reactions (sepsis) due to infection in pediatric liver cirrhosis patients. In liver cells, there was another improvement marked by an increase in the enzymes alanine aminotransferase (ALT) and hepatocyte growth factor (HGF).
The administration of G-CSF therapy did not show harmful side effects in patients and there was no high mortality rate in patients in the intervention group and the control group. Therefore, although the PELD score has not improved within 3 months, administration of G-CSF therapy in pediatric liver cirrhosis patients has clinical improvement benefits.
This can be the basis for further research with a certain age group, longer observation time, increasing the dose of G-CSF, and modifying the administration cycle. G-CSF therapy can be given to patients awaiting liver transplantation, especially in patients who have impaired immunity and a history of recurrent infections.
Thanks to his findings, dr. Tri Hening succeeded in obtaining a doctorate from FK UI, on Tuesday (19/7). Doctoral Promotion Session dr. Tri Hening led by the Dean of FK UI, Prof. Dr. dr. Ari Fahrial Syam, Sp.PD-KGEH, with the Promoter: Prof. Dr. dr. med. Akmal Taher, Sp. U(K) and Co-promoter: Prof. Dr. dr. Hanifah Oswari, Sp.A(K) and Dr. dr. Aria Kekalih, MTI
The trial examiner team was chaired by Prof. Dr. dr. Suhendro, Sp.PD-KPTI with members: Prof. Dr. dr. Rianto Setiabudy, Sp.FK.; dr. Alida Roswita Harahap, Sp.PK(K), Ph.D.; Prof. Dr. dr. Zakiudin Munasir, Sp.A(K); Prof. Dr. dr. Aryono Hendarto, Sp.A(K), MPH.; and Dr. dr. Akhmad Makhmudi, Sp.B, Sp.BA(K) from the Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada.