Liu G, Tang F, Wang T, Yan JQ, Li FH, Ha FS, Zhang X, Jing L, Liang J. Efficacy of recombinant human thrombopoietin in patients with acute-on-chronic liver failure and thrombocytopenia: A prospective, open-label study. World J Gastroenterol 2025; 31(14): 105004 [DOI: 10.3748/wjg.v31.i14.105004]
Corresponding Author of This Article
Jing Liang, MD, Chief Physician, Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, No. 83 Jintang Road, Tianjin 300170, China. haolele77@sina.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Clinical Trials Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Apr 14, 2025; 31(14): 105004 Published online Apr 14, 2025. doi: 10.3748/wjg.v31.i14.105004
Efficacy of recombinant human thrombopoietin in patients with acute-on-chronic liver failure and thrombocytopenia: A prospective, open-label study
Gang Liu, Fei Tang, Tao Wang, Jun-Qing Yan, Feng-Hui Li, Fu-Shuang Ha, Xu Zhang, Li Jing, Jing Liang
Gang Liu, Department of Internal Medicine, The Third Central Clinical College of Tianjin Medical University, Tianjin 300300, China
Gang Liu, Department of Internal Medicine, Tianjin Dongli Hospital, Tianjin 300300, China
Fei Tang, Tao Wang, Jun-Qing Yan, Feng-Hui Li, Fu-Shuang Ha, Xu Zhang, Jing Liang, Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, Tianjin 300170, China
Li Jing, Department of Medical Laboratory, The Third Central Hospital of Tianjin, Tianjin 300170, China
Co-first authors: Gang Liu and Fei Tang.
Author contributions: Liu G and Tang F contributed equally to this work; Liu G and Tang F wrote the paper; Ha FS, Li FH, Zhang X and Wang T collected the literature and data; Liang J revised the paper; Jing L done blood reagent testing and verification; All authors read and approved the final manuscript.
Supported by Tianjin Key Medical Discipline (Specialty) Construction Project, No. TJYXZDXK-034A.
Institutional review board statement: This study was approved by the Ethics Committee of Tianjin Third Central Hospital (No. IRB2121-001-01).
Clinical trial registration statement: This study was registered at chictr.org.cn (ChiCTR2100046728).
Informed consent statement: All enrolled patients provided informed consent prior to receiving treatment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: All data collected during the study are available from the corresponding author by request: Liang J, E-mail: haolele77@sina.com.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing Liang, MD, Chief Physician, Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, No. 83 Jintang Road, Tianjin 300170, China. haolele77@sina.com
Received: January 8, 2025 Revised: February 24, 2025 Accepted: March 24, 2025 Published online: April 14, 2025 Processing time: 92 Days and 18.5 Hours
Abstract
BACKGROUND
Patients with acute-on-chronic liver failure (ACLF) have a high mortality rate, poor prognosis, and often experience concurrent thrombocytopenia and bleeding events.
AIM
To evaluate the efficacy and safety of recombinant human thrombopoietin (rhTPO) in patients with ACLF with concomitant severe thrombocytopenia.
METHODS
This was a prospective, open-label study. We assigned 70 ACLF patients with severe thrombocytopenia into the rhTPO group and control group, with 35 patients in each group. Patients in the rhTPO group received subcutaneous injections of rhTPO at a dose of 15000 IU/day for 7 consecutive days, while patients in the control group did not receive rhTPO treatment. The primary endpoint was the proportion of patients with platelet count > 50 × 109/L on day 14.
RESULTS
The proportion of patients with platelet count > 50 × 109/L on day 14 was 60.7% in the rhTPO group, which was significantly higher than that (12.0%) in the control group (P < 0.001). The platelet count in the rhTPO group on day 14 was 64 × 109/L, exceeding the baseline of 28 × 109/L. Compared to the control group, the rhTPO group exhibited a significant increase in platelet count from baseline (P < 0.05). Model for end-stage liver disease score, albumin level and international normalized ratio improved significantly from baseline on day 14 after rhTPO injection. The concentrations of serum thrombopoietin and hepatocyte growth factor in the rhTPO group after 7 days were 143.7 and 195.4 pg/mL, respectively, showing a significant increase from baseline (P < 0.05). Eight (22.9%) patients had bleeding events in the control group compared with four (11.4%) in the rhTPO group. The incidence of 90-day mortality was also higher in the control group (6, 17.1%) than that in the rhTPO group (3, 8.6%).
CONCLUSION
rhTPO significantly increased the platelet count in ACLF patients with thrombocytopenia and reduce the occurrence of bleeding events, with a good safety profile.
Core Tip: Patients with acute-on-chronic liver failure (ACLF) have a high mortality rate and poor prognosis. They often experience concurrent thrombocytopenia and bleeding events. This study aimed to evaluate the efficacy and safety of recombinant human thrombopoietin (rhTPO) in ACLF patients with concomitant severe thrombocytopenia. We assigned 70 ACLF patients with severe thrombocytopenia into the rhTPO group and the control group, with 35 patients in each group. Patients in the rhTPO group received subcutaneous injections of rhTPO for 7 consecutive days, while those in the control group did not receive rhTPO treatment. The platelet count in the rhTPO group increased significantly from the baseline. The model for end-stage liver disease score, albumin level, and international normalized ratio in patients of the rhTPO group improved significantly from the baseline on day 14 after rhTPO injection. In summary, rhTPO can significantly increase the platelet count in ACLF patients with thrombocytopenia, help improve liver function, and reduce the occurrence of bleeding events. It also has a good safety profile.
