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.

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

Core tip: The elevated number of proposals reported for more than forty years reveals the lack of efficacy of a particular therapeutic modality for severe alcoholic hepatitis. This review summarizes data regarding the favorable effects of extracorporeal liver support, particularly with respect to the improvement of systemic hemodynamics, hepatic encephalopathy and renal function, thus sustaining that the procedure used alone or in combination with pharmacological therapies may have a role in this clinical condition.