Granulocyte-monocyte/macrophage apheresis for steroid-nonresponsive or steroid-intolerant severe alcohol-associated hepatitis: A pilot study

• Published in: Hepatology communications 2024-02, Vol.8 (2)
• Main Authors: Kasuga, Ryosuke, Chu, Po-Sung, Taniki, Nobuhito, Yoshida, Aya, Morikawa, Rei, Tabuchi, Takaya, Noguchi, Fumie, Yamataka, Karin, Nakadai, Yukie, Kondo, Mayuko, Ebinuma, Hirotoshi, Kanai, Takanori, Nakamoto, Nobuhiro
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones; Blood Component Removal; End Stage Liver Disease; Granulocytes; Hepatitis, Alcoholic - diagnosis; Hepatitis, Alcoholic - therapy; Humans; Macrophages; Monocytes; Original; Pilot Projects; Prospective Studies; Severity of Illness Index; Steroids
• ISSN: 2471-254X; 2471-254X
• DOI: 10.1097/HC9.0000000000000371

Patients with severe alcohol-associated hepatitis (SAH) have a high short-term mortality rate. Unmet needs exist in patients who are refractory to corticosteroids (CS) or are ineligible for early liver transplantation. This was a prospective, open-label, nonrandomized pilot study conducted at a liver transplant center in Tokyo, Japan, starting in October 2015. Lille model and Model for End-stage Liver Disease (MELD) score-defined CS nonresponsive or CS-intolerant patients with SAH who fulfilled the inclusion criteria (leukocytosis over 10,000/μL, etc.) were considered for enrollment. The median duration from admission to enrollment was 23 days (IQR, 14-31 days), after standard of care. Granulocyte-monocyte/macrophage apheresis (GMA) performed with Adacolumn twice per week, up to 10 times per treatment course, was evaluated. 13 GMA treatments were conducted through December 2021. Maddrey Discriminant Function was 53.217.7 at admission. The overall survival rate was 90.9% at 90 and 180 days. MELD scores significantly improved, from median (IQRs) of 23 (20-25) to 15 (13-21) after GMA (p