Case Report

Digestive Diseases and Sciences

, Volume 59, Issue 2, pp 482-488

First online:

Granulocytapheresis for the Treatment of Severe Alcoholic Hepatitis: A Case Series and Literature Review

  • Kenya KamimuraAffiliated withDivision of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University Email author 
  • , Michitaka ImaiAffiliated withDivision of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University
  • , Akira SakamakiAffiliated withDivision of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University
  • , Shigeki MoriAffiliated withDepartment of Gastroenterology and Hepatology, Shinrakuen Hospital
  • , Masaaki KobayashiAffiliated withDivision of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University
  • , Ken-ichi MizunoAffiliated withDivision of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University
  • , Manabu TakeuchiAffiliated withDivision of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University
  • , Takeshi SudaAffiliated withDivision of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University
  • , Minoru NomotoAffiliated withDivision of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University
    • , Yutaka AoyagiAffiliated withDivision of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University

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Abstract

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.

Keywords

Severe alcoholic hepatitis Granulocytapheresis Leukocytapheresis IL-6 IL-8