Skip to main content
Log in

Exacerbated autoimmune hepatitis successfully treated with leukocytapheresis and bilirubin adsorption therapy

  • Case Report
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

A 58-year-old man with subacute fulminant onset of autoimmune hepatitis (AIH) was treated by leukocytapheresis (LCAP) and bilirubin adsorption therapy (BAT), rather than by administration of highdose corticosteroids as he had mild glucose intolerance, and a definitive diagnosis of AIH was not obtained on admission; further, there was a risk of viral infection. After initiation of the therapies, serum transaminases and bilirubin, immunoglobulins, anti-nuclear antibodies, and rheumatoid factor decreased rapidly, as did the initially high levels of activated cells and several pro-inflammatory cytokines. Liver inflammation observed on liver biopsy settled during the course of the therapies, with no adverse side effects. A pause in the therapies was associated with deterioration; however, restoration of apheresis was followed by normalization. Remission was sustained throughout the period monitored, except for a recurrence 14 months after discharge, which was successfully resolved by two additional LCAP sessions. These results suggest that LCAP influences the causal mechanism(s) of exacerbation of AIH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Schlaak JF, Löhr H, Gallati H, et al. Analysis of the in vitro cytokine production by liver-infiltrating T cells of patients with autoimmune hepatitis. Clin Exp Immunol 1993;94:168–173.

    PubMed  CAS  Google Scholar 

  2. Barnaba V, Levrero M, Franco A, et al. Characterization of effector cells in lymphocytotoxicity to autologous hepatocytes in HBsAg-positive and autoimmune chronic active hepatitis (CAH). Liver 1986;6:45–52.

    PubMed  CAS  Google Scholar 

  3. AVA Lobo-Yeo, Alviggi L, Giorgina Mieli-Vergani, et al. Preferential activation of helper/inducer T cell lymphocytes in autoimmune chronic active hepatitis. Clin Exp Immunol 1987;67:95–104.

    PubMed  CAS  Google Scholar 

  4. Mackay IR. Autoimmune hepatitis: The realities and the uncertainties. Gastroenterol Jap 1991;26(1):102–108.

    CAS  Google Scholar 

  5. Meyer zum Büschenfeld KH, Lohse AW, Manns M, et al. Autoimmunity and liver disease. Hepatology 1990;12:354–362.

    Article  Google Scholar 

  6. Czaja AJ. Low-dose corticosteroid therapy after multiple relapses of severe HBsAg-negative chronic active hepatitis. Hepatology 1990;11:1044–1049.

    Article  PubMed  CAS  Google Scholar 

  7. Nouri-Aria KT, Hegarty JE, Alexander GJM, et al. Effect of corticosteroids on suppressor-cell activity in autoimmune and viral chronic active hepatitis. N Engl J Med 1982;307:1301–1304.

    PubMed  CAS  Google Scholar 

  8. Chase WF, Winn RE, Mayes GR. Oral pulse prednisone therapy in the treatment of HBsAg-negative chronic active hepatitis. Gastroenterology 1982;83:1292–1296.

    PubMed  CAS  Google Scholar 

  9. Hegarty JE, Nouri Aria KT, Portmann B, et al. Relapse following treatment withdrawal in patients with autoimmune chronic active hepatitis. Hepatology 1983;3:685–689.

    Article  PubMed  CAS  Google Scholar 

  10. Czaja AJ, Beaver SJ, Shiels MT. Sustained remission after corticosteroid therapy of severe hepatitis B surface antigennegative chronic active hepatitis. Gastroenterology 1987;92:215–219.

    PubMed  CAS  Google Scholar 

  11. Wang KK, Czaja AJ, Beaver SJ, et al. Extrahepatic malignancy following long-term immunosuppressive therapy of severe hepatitis B surface antigen-negative chronic active hepatitis. Hepatology 1989;10:39–43.

    Article  PubMed  CAS  Google Scholar 

  12. Stellon AJ, Keating JJ, Johnson PJ, et al. Maintenance of remission in autoimmune chronic active hepatitis with azathioprine after a corticosteroid withdrawal. Hepatology 1990;11:1044–1049.

    Article  Google Scholar 

  13. Czaja AJ. Low-dose corticosteroid therapy after multiple relapses of severe HBsAg-negative chronic active hepatitis. Hepatology 1990;11:1044–1049.

    Article  PubMed  CAS  Google Scholar 

  14. Sawada K, Malchesky PS, Nosé Y. Available removal systems: State of the art. In: Nydegger UE (ed) Therapeutic hemapheresis in the 1990s. Current studies in hematology and blood transfusion. Basel: Karger, 1990;57:51–113.

    Google Scholar 

  15. Sawada K, Ohnishi K, Fukui S, et al. Leukocytapheresis therapy, performed with leukocyte removal filter, for inflammatory bowel disease. J Gastroenterol 1995;30:322–329.

    Article  PubMed  CAS  Google Scholar 

  16. Ohnishi K, Sawada K, Nakasho K, et al. Impovement in a patient with alcohol-induced liver dysfunction with biliary stasis and renal damage treated by bilirubin adsorption therapy. Jpn J Apheresis 1995;14(1):93–94.

    Google Scholar 

  17. Nakasho K, Sawada K, Wada M, et al. A case of autoimmune hepatitis with multinucleated giant hepatocytes (in Japanese with English abstract). Nippon Shokakibyo Gakkai Zasshi (Jpn J Gastroenterol) 1996;93(4):266–271.

    PubMed  CAS  Google Scholar 

  18. Conn HO. Trailmaking and number-connection tests in the assessment of mental state in portal systemic encephalopathy. Am J Dig Dis 1977;22(6):541–550.

    Article  PubMed  CAS  Google Scholar 

  19. Aoyama T, Ino Y, Ozeki M, et al. Pharmacological studies of FUT-175, nafamostat mesylate. I. Inhibition of protease activity in in vitro and in vivo experiments. Jpn J Pharmacol 1984;35:203–227.

    PubMed  CAS  Google Scholar 

  20. Obayashi T, Tamuta H, Tanaka S, et al. Removal of limulus test interfering factors in blood samples with perchloric acid and the improvement of the specificity of the limulus test by fractionating amebocyte lysate. Prog Clin Biol Res, 1987:231:357–369.

    PubMed  CAS  Google Scholar 

  21. Tanaka J, Sato T, Malchesky PS, et al. Endotoxin removal by plasma perfusion over an anion exchange resin in obstructive jaundice. In: Agishi T, Kawamura A, Mineshima M (eds) Therapeutic plasmapheresis XII. Utrecht: VSP, 1993:495–498.

    Google Scholar 

  22. Endo L, Corman LC, Panush RS. Clinical utility of assays for circulating immune complexes. Med Clin North Am 1985;69:623–636.

    PubMed  CAS  Google Scholar 

  23. Ida N, Sakurai S, Hosaka T, et al. An enzyme-linked immunosorbent assay for the measurement of human interleukin-6. J Immunol Methods 1990;133:279–284.

    Article  PubMed  CAS  Google Scholar 

  24. Endo Y, Tani T, Hanasawa K, et al. The collaborative factors to treat hepatic failure by blood purification. Jpn J Apheresis 1996;15(1):33–35.

    Google Scholar 

  25. Mondelli MU, Manns M, Ferrari C. Does the immune response play a role in the pathogenesis of chronic liver disease? Arch Pathol Lab Med 1988;112:489–487.

    PubMed  CAS  Google Scholar 

  26. Imawari M, Nomura M, Kaieda T, et al. A human T cell clone cytotoxic for hepatocytes from patients with chronic non-A, non-B hepatitis. Gastroenterol Jap 1990;25(2):77–81.

    Google Scholar 

  27. Hyams JS, Ballow M, Leichtner AM. Cyclosporine treatment of autoimmune chronic active hepatitis. Gastroenterology 1987;93: 890–893.

    PubMed  CAS  Google Scholar 

  28. Amano K, Ezaki H, Fujimoto K, et al. Leukapheresis for autoimmune diseases. In: Oda T, editor. Therapeutic plasmapheresis IX. Cleveland: International Society for Artificial Organs (ISAO) Press, 1991;423–425.

    Google Scholar 

  29. Sawada K, Ohnishi K, Nanjyo T, et al. Efficacy and safety of leukocytapheresis therapy with leukocyte removal filter for patients with primary biliary cirrhosis. Jpn J Apheresis 1995;14:95–96.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

A pathology report of this case has been reported, in part, in theJapanese Journal of Gastroenterology (in Japanese) (Vol. 93, No 4, 1996)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sawada, K., Ohnishi, K., Kosaka, T. et al. Exacerbated autoimmune hepatitis successfully treated with leukocytapheresis and bilirubin adsorption therapy. J Gastroenterol 32, 689–695 (1997). https://doi.org/10.1007/BF02934123

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02934123

Key words

Navigation