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Sequential therapy consisting of glucocorticoid infusions followed by granulocyte–monocyte absorptive apheresis in patients with severe alcoholic hepatitis

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Activated leukocytes infiltrating the liver contribute to the provocation of alcoholic hepatitis. Glucocorticoid induces the demargination of leukocytes from the hepatic sinusoids, whereas granulocyte–monocyte absorptive apheresis (GMA) removes leukocytes from the circulation. Thus, the usefulness of a sequential therapy consisting of glucocorticoid infusions followed by GMA was evaluated in patients with severe alcoholic hepatitis.

Methods

Patients with severe alcoholic hepatitis received intravenous injections of methylprednisolone (1,000 mg/day) for 3 or 4 days, and then GMA was performed every day for 3 days. Responders were defined as those with attenuated serum C-reactive protein (CRP) levels during the GMA procedures.

Results

Ten consecutive patients were enrolled. At the baseline, the Japan alcoholic hepatitis scores were 9 in two patients and 10 or more in eight patients, and the Model for End-Stage Liver Disease scores ranged from 22 to 43. In all the patients, the peripheral neutrophil counts increased and the serum levels of CRP, aspartate aminotransferase, IL-6, IL-8, TNF-α, and intercellular adhesion molecule 1 decreased immediately after the glucocorticoid infusions. However, a rebound increase in the serum CRP levels was observed in all patients after discontinuation of glucocorticoid infusions, but the maximal values during the GMA procedures were lower than the baseline values. Six patients were rescued, whereas the remaining four patients died because of sepsis, pneumonia, pancreatitis, and renal failure.

Conclusions

Sequential therapy combining glucocorticoid infusion and GMA was useful for attenuating liver injuries in patients with severe alcoholic hepatitis by preventing rebound increases in inflammatory reactions after discontinuation of glucocorticoid infusions, except in patients with bacterial infections and/or multiple organ failure.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-cho, Iruma-gun, Saitama, 350-0495, Japan

    Kazuhiro Watanabe, Yoshihito Uchida, Kayoko Sugawara, Kayoko Naiki, Mie Inao, Nobuaki Nakayama & Satoshi Mochida

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  1. Kazuhiro Watanabe
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  2. Yoshihito Uchida
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  3. Kayoko Sugawara
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  5. Mie Inao
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  6. Nobuaki Nakayama
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Correspondence to Satoshi Mochida.

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Conflict of interest

Satoshi Mochida has received research grants from A2 Healthcare Co., Abbvie GK, Bristol-Myers Squibb Co., Chugai Pharmaceutical Co. Ltd, Eisai Co. Ltd, Mitsubishi Tanabe Pharma Co., MSD K.K., Sumitomo Dainippon Pharma Co., and Toray Medical Co. Ltd, has received speaking fees or honoraria from Abbive GK, Ajinomoto Pharmaceuticals Co. Ltd, Bristol-Myers Squibb Co., Gilead Sciences Inc., MSD K.K., Sumitomo Dainippon Pharma Co., and Toray Medical Co. Ltd, and has received patent royalties from SRL Inc. Kazuhiro Watanabe, Yoshihito Uchida, Kayoko Sugawara, Kayoko Naiki, Mie Inao, and Nobuaki Nakayama declare that they have no conflict of interest.

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Watanabe, K., Uchida, Y., Sugawara, K. et al. Sequential therapy consisting of glucocorticoid infusions followed by granulocyte–monocyte absorptive apheresis in patients with severe alcoholic hepatitis. J Gastroenterol 52, 830–837 (2017). https://doi.org/10.1007/s00535-016-1287-9

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  • DOI: https://doi.org/10.1007/s00535-016-1287-9

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