Perioperative Treatment With G-CSF Reduces Post-Op Infections

Laurie Barclay, MD

December 30, 2003

Dec. 30, 2003 — Perioperative treatment with recombinant human granulocyte colony-stimulating factor (Filgrastim; G-CSF) reduces infectious complications of major surgery, according to the results of a randomized trial published in the January issue of the Annals of Surgery. The investigators suggest that further study is warranted.

"Severe trauma, such as major surgery, initiates acute immunodysfunction which predisposes the patient towards infectious complications," write Christian Schneider, MD, from Ludwig-Maximilians-University in Munich, Germany, and colleagues. "G-CSF seems to be a promising candidate to signal the immune system to prepare for defense, while not activating immune cells directly, and to limit the inflammatory response by attenuating monocytes, allowing more moderate reactions but not paralyzing these regulators."

In this study, 60 patients undergoing elective surgery received perioperative G-CSF or placebo. In patients receiving G-CSF, leukocyte counts and serum levels of anti-inflammatory mediators IL-1ra and TNF-R increased, and the postoperative acute phase response was attenuated.

Reduced TNF-a release and HLA-DR expression suggesting monocyte deactivation and impaired mitogenic proliferation and reduced TH1 lymphokine release reflecting lymphocyte anergy were blunted in the G-CSF group. Compared with the placebo group, both the incidence and the severity of postoperative infectious complications were reduced (5 infections [13%] in 40 in the G-CSF group vs. 6 infections [30%] in 20 patients in the control group, including two deaths).

G-CSF was well tolerated overall. Blood loss during surgery was 1,650 ± 266 mL in the G-CSF group and 1,078 ± 164 mL in the placebo group ( P = not significant). Time spent in the intensive care unit and average hospitalization time did not differ significantly between groups.

"These results suggest that Filgrastim treatment reinforces innate immunity, enabling better prevention of infection," the authors write. "Thus, this unique combination of hematopoietic, anti-inflammatory and anti-infectious effects on the innate immune system warrants further study of clinical efficacy and sepsis prophylaxis."

Ann Surg. 2003;239:75-81

Reviewed by Gary D. Vogin, MD

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