Granulocytapheresis for the treatment of severe alcoholic hepatitis: a case series and literature review.
Severe alcoholic hepatitis has a high mortality rate due to limited therapeutic methods. Although corticosteroids have been used to control the inflammatory response, the outcomes vary and no standardized therapy has been established. Novel therapeutic approaches, such as anti-TNF-α, pentoxifilline, and others have been tested clinically on the basis of their cytokinemic pathophysiology with limited success. However, treatment of leukocytosis that causes cytokinemia and hepatic inflammation in patients via granulocytapheresis and leukocytapheresis showed promising results in a number of reports. Here, we report two cases of severe alcoholic hepatitis treated with granulocytapheresis. The liver function and inflammation recovered after the therapy. A review of 35 cases treated with granulocytapheresis and leukocytapheresis demonstrated their efficacy in treating alcoholic hepatitis by controlling leukocytosis as well as cytokines such as IL-8. Multidisciplinary treatment for severe alcoholic hepatitis should be considered case by case on the basis of the complexity and severity of the condition.
Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachido-ri, Chuo-ku, Niigata, 951-8510, Japan, kenya-k@med.niigata-u.ac.jp.
Kenya
K
Kamimura
Michitaka
M
Imai
Akira
A
Sakamaki
Shigeki
S
Mori
Masaaki
M
Kobayashi
Ken-Ichi
K
Mizuno
Manabu
M
Takeuchi
Takeshi
T
Suda
Minoru
M
Nomoto
Yutaka
Y
Aoyagi
D015415:Biomarkers / Q000097:blood; D016207:Cytokines / Q000097:blood; D005260:Female; D006098:Granulocytes / Q000276:immunology*; D006519:Hepatitis, Alcoholic / Q000097:blood / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007937:Leukapheresis / Q000379:methods*; D007964:Leukocytosis / Q000097:blood / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D008875:Middle Aged; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D015415:Biomarkers; D016207:Cytokines; D018836:Inflammation Mediators