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Granulocytapheresis (GCAP) for severe alcoholic hepatitis-A preliminary report
Ryukichi Kumashiro1, Yuriko Koga, Reiichirou Kuwahara
1The Second Department of Medicine, Division of Kidney Disease and Critical Care Medicine, Kurume University, School of Medicine, Kurume, Fukuoka 830-0011, Japan.
Aim:
To evaluate the efficacy of granulocytapheresis therapy in alcoholic hepatitis.
Methods:
We attempted to trap leukocytes in the peripheral circulation using the granulocytapheresis (GCAP) technique in patients with severe alcoholic hepatitis who showed a marked elevation of peripheral leukocytes. Corticosteroids were co-administered.
Results:
The Maddrey's indices for these patients varied between 42 and 117 and MELD scores for alcoholic hepatitis (Mayo) ranged from 20 to 44. Survival rate was 50% (3/6), which is better than the results reported recently for similar patients in a national survey (29%). The effect of GCAP was reflected in decreases in interleukin-6 and interleukin-8 levels as well as in serum concentrations of soluble intercellular adhesion molecule. White blood cell counts were not affected. In the surviving patients, the Maddrey's indices and MELD scores for alcoholic hepatitis varied between 49 and 67, and 20 and 22, respectively, showing that GCAP is effective in patients with disease of moderate severity. Hemolytic anemia occurred in one patient after GCAP therapy. Other events such as pancreatitis, pneumonia, and cerebral hemorrhage were considered to be related to the alcoholic hepatitis itself.
Conclusion:
GCAP therapy deserves further evaluation as a new therapeutic modality for a moderately severe alcoholic hepatitis.
