Biliary Atresia, Granulocyte Colony-stimulating Factor
Conditions
Brief summary
The aim of the study is to evaluate the use of Granulocyte Colony Stimulating Factor (GCSF) on the clinical and biochemical outcome of type 3 biliary atresia post kasai.
Detailed description
Biliary atresia (BA) is a devastating disease manifest early in infancy characterized by bile duct injury and extrahepatic biliary obstruction, leading to cirrhosis in the majority of infants. Although BA is a rare disease, occurring in \ 1 in 5600 to 1 in 18,000 infants worldwide, it is considered the most common indication for liver transplantation in children. However, despite a 50-60% rate of initial jaundice clearance, liver transplantation by 2 years of age is necessary for long term survival in many of the post-Kasai patients. GCSF cytokine that stimulates neutrophil and hematopoietic stem cell (HSC) production and mobilization from the bone marrow, and has served as a complementary agent to bone marrow stem cell therapy for patients with congenital or acquired diseases of bone marrow suppression. Granulocyte colony-stimulating factor (G-CSF) mobilizes CD34+(cluster of differentiation34) cells, these CD34+ cells increase hepatocyte growth factor inducing the proliferation of hepatic progenitor cells within 7 days. In experimental liver diseases of toxin-induced or bile duct ligation-induced liver injury, GCSF-based stem cell therapy has the same effects as direct HSC transplantation on improving liver regeneration and suppressing the inflammatory and fibrotic responses to hepatic injury. The cellular and molecular mechanisms are unknown but are postulated to be derived from the many paracrine actions of GCSF.
Interventions
DRUGGranulocyte Colony-Stimulating Factor
20 patients will receive subcutaneous GCSF at a daily dose of 10ug/kg for 3 consecutive days. It is administered within 3-4 days after the Kasai procedure.
Sponsors
National Liver Institute, Egypt
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Protocol of cohort study will be conducted on 40 infants with the final diagnosis of biliary atresia type 3 (supported by the liver histology and intra-operative findings) divided into two groups one of them is for GCSF after Kasai operation, and the other group will be without GCSF therapy and their data will be collected retrospectively.
Eligibility
Sex/Gender
ALL
Age
20 Days to 1 Years
Healthy volunteers
Yes
Inclusion criteria
* Infants with initial diagnosis of biliary atresia with biliary atresia score \> 23.927 will be allocated for Kasai porto-enterostomy with intra-operative cholangiogram reaching type 3 biliary atresia anatomy as a final diagnosis.
Exclusion criteria
* Major cardiac, renal, pulmonary, neurological malformations or illnesses. * Hemoglobinopathies, such as sickle cell anemia * Active systemic infection. * White blood cell count \> 20,000 cells/mm3. * Platelet count \< 40,000 cells/mm3 or ≥ 800,000 cells/mm3. * Purpura fulminans or unexplained vascular thrombotic conditions.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of subjects with serum TBi (total bilirubin) ≥ 2 mg/dL at 3 months. | baseline | Proportion of subjects with serum TBi (total bilirubin) ≥ 2 mg/dL at 3 months will be analyzed using generalized linear mixed effects model (GLMM) with a logistic link function for the covariates as fixed effects, with study sites as random effect to control for site variability in management practices and patient characteristics. The covariates are potential confounders for poor outcome, such as age at the time of Kasai, presence of ductal plate malformation, cholangitis and possibly CMV IgM(cytomegalovirus immune globulin M antibodies) positivity. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Differences in the proportion of subjects with cholangitis at 6 months. | base line | Differences in the proportion of subjects with cholangitis at 6 months will be calculated using the generalized linear mixed effect model with logistic link function for the covariates described in the primary outcome, with study sites as random effect to control for site variability in management practices and patient characteristics. |
Countries
Egypt
Contacts
Primary ContactMarwa Narwa Foad Asker, master
Backup ContactBehairy Behairy El Sayed Behairy, MD
Outcome results
None listed