Extracorporeal liver support in severe alcoholic hepatitis

Abstract

The severity of alcoholic hepatitis (AH) which may coexist with cirrhosis varies greatly, from asymptomatic forms which are detected in alcoholic patients without any sign of liver disease, except laboratory abnormalities, to severe forms characterised by deep jaundice, ascites, hepatic encephalopathy and low prothrombin index. In hospitalized patients the mortality could be as high as 75%. The elevated number of therapeutic proposals reported for more than forty years reveals the lack of efficacy of a particular modality. Even in the most favorable trials, the survival is already very poor and in some cases related to the development of renal failure or hepatorenal syndrome. There are some motivating reports concerning albumin dialysis as a support treatment in patients with severe AH, either alone or in combination with other pharmacological therapies. The favorable effects of albumin dialysis in patients with severe AH suggest that the procedure used alone or in combination with other therapies may have a role in this clinical condition. This will be particularly relevant to offer an alternative therapy in these patients, thus being a potential bridge to recovery or to be listed for liver transplantation.

Trial registration: ClinicalTrials.gov NCT01829347.

Keywords: Acute alcoholic hepatitis; Alcoholic liver disease; Extracorporeal liver support; Hepatorenal syndrome; Molecular Adsorbents Recirculating System; Treatment of alcoholic hepatitis.

Figures

Figure 1

Changes in circulating levels of total bilirubin and plasma renin activity before and after each 7-h molecular adsorbent recirculating system session performed on 10 patients with severe alcoholic hepatitis (gray shaded bars). Ten days later there was a recovery of these levels although they were lower than before treatment (P = NS). aP < 0.05 vs before and after each molecular adsorbent recirculating system (MARS) session.

Figure 2

Tumor necrosis factor-α (TNF-α) levels before and after molecular adsorbent recirculating system treatment in patients with severe alcoholic hepatitis. Although no significant decrease was observed in the circulating TNF-α, the dialysate was enriched with this cytokine, thus indicating that albumin dialysis is able to remove some substances related to the pathogenesis of the disease.

Figure 3

Cumulated survivals of the ten patients with severe alcoholic hepatitis treated with 3 consecutive 7-h molecular adsorbent recirculating system sessions. Fifty percent of the patients were still alive 6 mo after treatment, and 40 percent survived 20 mo.