| Background: Alcoholic hepatitis (AH) is an acute hepatic manifestation occurring from heavy alcohol congestion. Although corcicosteroids are widely used against severe AH (SAH), there is little evidence for the long-term prognosis. Here, we aimed to investigate the efficacy and safety of granulocytes/monocytes apheresis (GMA) therapy against SAH based on the evidence that high WBC counts is the poor prognosis factor. Methods: We conducted a single-arm interventional study for patients with SAH whose WBC counts > 10,000/μl from 2004 to 2008. 24 patients received GMA therapy twice a week for a total of four times. Results: 3-month survival rate following GMA was 75% (18/24), which is better than that reported previously. Multivariate analysis revealed that serum TB level, PT, and WBC count were correlated with the prognosis. Since 2011, we have preceded steroid treatment and added GMA therapy to steroid ineffective cases using Lille model, a scoring to predict the effects of steroids. in this prospective study, three patients achieved a successful outcome (Lille score 0.08 ± 0.02) by steroid monotherapy and the 3-month survival rate was 67 % (2/3). Of interest, seven patients ineffective for steroid therapy (Lille score 0.79 ± 0.18) received additional GMA therapy, and the survival rate was 57 % (4/7). Conclusion: GMA therapy improved the prognosis of SAH in steroid-resistant cases, suggesting that GMA can be a treatment option before liver transplantation. |
