Adacolumn Granulocyte-Apheresis for Alcoholic Hepatitis: Preliminary Study.
BACKGROUND
Alcoholic hepatitis (AH) is an acute-on-chronic inflammatory response affecting the liver. It has been recognized that white blood cells (WBCs) are involved in the pathogenesis and in the prognosis of AH. The aim of study was to use Adacolumn, which can selectively adsorb myeloid linage leucocytes (granulocytes and monocytes/macrophages) from the blood in the column and improve the clinical status of patients.


METHODS
Six patients with a diagnosis of AH were treated with Adacolumn granulocyte-apheresis therapy.


METHODS
patients not responders to corticosteroids therapy with Maddrey Discriminant Function (MDF) >32 and MELD score 20-26. The patients underwent five 1-hour sessions for 5 consecutive days with a follow-up at 28 days. The column was placed in an extracorporeal setting with a perfusion rate of 30 mL/min and a duration of 60 minutes. Liver parameters, WBC count, proinflammatory cytokines, coagulation, and predictive scores were valued before and after the cycle of apheresis treatment.


RESULTS
After 5 days, the findings showed a significant improvement of WBC count (P < .014) and cytokines such as interleukin (IL)-6 (P < .019), tumor necrosis factor α (TNFα) (P < .02), and IL-8 (P < .029). The results probably determined a reduction of aspartate transaminase (AST; P < .02) and alanine transaminase (ALT; P < .011), although we did not observe a significant improve in bilirubin, prothrombin time (PT), and Maddrey score. The improvement of MELD score, depending on an improvement of international normalized ratio for administration of plasma, was not considered. At day 28 of follow-up, PT, IL-6, TNFα, AST and ALT results significantly improved.


CONCLUSIONS
The Adacolumn apheresis was safe and was able to determine an improvement of clinical status of patients with reduction of inflammatory markers. More patients are needed to validate these results.
Italian National Transplant Center, Rome, Italy. Electronic address: vemorabito@gmail.com.
V
V
Morabito
Department of Aerospace and Mechanical Engineering, Sapienza University of Rome, Rome, Italy.
S
S
Novelli
Italian National Transplant Center, Rome, Italy.
L
L
Poli
Department of Infectious Disease, Sapienza University of Rome, Rome, Italy.
G
G
Ferretti
Department of Anesthesia and Intensive Care, Sapienza University of Rome, Rome, Italy.
F
F
Ruberto
Department of Anesthesia and Intensive Care, Sapienza University of Rome, Rome, Italy.
F
F
Pugliese
Italian National Transplant Center, Rome, Italy.
R
R
Pretagostini
Italian National Transplant Center, Rome, Italy.
P B
PB
Berloco
Italian National Transplant Center, Rome, Italy.
M
M
Rossi
D000328:Adult; D000410:Alanine Transaminase / Q000378:metabolism; D001663:Bilirubin / Q000097:blood; D001780:Blood Coagulation Tests; D005260:Female; D006098:Granulocytes; D006519:Hepatitis, Alcoholic / Q000378:metabolism / Q000628:therapy*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007937:Leukapheresis; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged
C508600:IL6 protein, human; D015850:Interleukin-6; D016209:Interleukin-8; D000410:Alanine Transaminase; D001663:Bilirubin