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

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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.

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Acknowledgments

We acknowledge Takao Tsuchida from the Division of Gastroenterology and Hepatology at Niigata University for the excellent assistance in histological staining. The authors would like to thank Enago for the English language review.

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Authors and Affiliations

  1. 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 Kamimura, Michitaka Imai, Akira Sakamaki, Masaaki Kobayashi, Ken-ichi Mizuno, Manabu Takeuchi, Takeshi Suda, Minoru Nomoto & Yutaka Aoyagi

  2. Department of Gastroenterology and Hepatology, Shinrakuen Hospital, Shindoriminami 3-3-11, Nishi-ku, Niigata, 950-2087, Japan

    Shigeki Mori

Authors
  1. Kenya Kamimura
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  2. Michitaka Imai
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  3. Akira Sakamaki
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  4. Shigeki Mori
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  5. Masaaki Kobayashi
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  6. Ken-ichi Mizuno
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  7. Manabu Takeuchi
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  8. Takeshi Suda
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  9. Minoru Nomoto
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  10. Yutaka Aoyagi
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Corresponding author

Correspondence to Kenya Kamimura.

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The clinical course of case 1 is from Kamimura K et al. Kanzo (2002) 43:316-321 with permission from the Japan Society of Hepatology.

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Kamimura, K., Imai, M., Sakamaki, A. et al. Granulocytapheresis for the Treatment of Severe Alcoholic Hepatitis: A Case Series and Literature Review. Dig Dis Sci 59, 482–488 (2014). https://doi.org/10.1007/s10620-013-2871-y

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  • DOI: https://doi.org/10.1007/s10620-013-2871-y

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