Extracorporeal liver assist device for alcoholic hepatitis: A potential silver lining?

Extracorporeal liver assist device for alcoholic hepatitis: A potential silver lining? AbbreviationsAASLDAmerican Association for the Study of Liver DiseasesAHalcoholic hepatitisEASLEuropean Association for the Study of the LiverELADextracorporeal cellular therapyGCSFgranulocyte colony stimulating factorILinterleukinINRinternational normalized ratiomDFMaddrey's discriminant functionMELDModel for End‐Stage Liver DiseaseNACN‐acetylcysteineRAreceptor antagonistSOCstandard of careAlcoholic hepatitis (AH) describes a spectrum of liver injury caused by chronic, heavy alcohol use, marked clinically by jaundice and histologically by hepatocellular necrosis and apoptosis, inflammation, and fibrosis. Although several formulas are used to assess the prognosis of AH (ie, Maddrey's discriminant function [mDF], Model for End‐Stage Liver Disease [MELD], Glasgow scale, and albumin/bilirubin/international normalized ratio [INR]/creatinine score), the absence of an unequivocally effective medical therapy limits their utility. Current American Association for the Study of Liver Diseases (AASLD) and European Association for the Study of the Liver (EASL) guidelines endorse prednisolone as the first‐line treatment for patients with mDF ≥ 32, with pentoxifylline being considered for patients with exclusions to prednisolone treatment (eg, uncontrolled infection, renal failure, hepatitis B, uncontrolled diabetes).Unfortunately, prednisolone is not very effective. Several studies, as well as meta‐analyses, suggest a modest improvement in 1‐month survival among patients receiving prednisolone. However, no study has shown an improvement in 3‐month or 6‐month survival with prednisolone treatment. The ineffectiveness of prednisolone in improving 3‐6–month survival http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Liver Transplantation Wiley

Extracorporeal liver assist device for alcoholic hepatitis: A potential silver lining?

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Publisher
Wiley Subscription Services, Inc., A Wiley Company
Copyright
© 2018 by the American Association for the Study of Liver Diseases.
ISSN
1527-6465
eISSN
1527-6473
D.O.I.
10.1002/lt.25020
Publisher site
See Article on Publisher Site

Abstract

AbbreviationsAASLDAmerican Association for the Study of Liver DiseasesAHalcoholic hepatitisEASLEuropean Association for the Study of the LiverELADextracorporeal cellular therapyGCSFgranulocyte colony stimulating factorILinterleukinINRinternational normalized ratiomDFMaddrey's discriminant functionMELDModel for End‐Stage Liver DiseaseNACN‐acetylcysteineRAreceptor antagonistSOCstandard of careAlcoholic hepatitis (AH) describes a spectrum of liver injury caused by chronic, heavy alcohol use, marked clinically by jaundice and histologically by hepatocellular necrosis and apoptosis, inflammation, and fibrosis. Although several formulas are used to assess the prognosis of AH (ie, Maddrey's discriminant function [mDF], Model for End‐Stage Liver Disease [MELD], Glasgow scale, and albumin/bilirubin/international normalized ratio [INR]/creatinine score), the absence of an unequivocally effective medical therapy limits their utility. Current American Association for the Study of Liver Diseases (AASLD) and European Association for the Study of the Liver (EASL) guidelines endorse prednisolone as the first‐line treatment for patients with mDF ≥ 32, with pentoxifylline being considered for patients with exclusions to prednisolone treatment (eg, uncontrolled infection, renal failure, hepatitis B, uncontrolled diabetes).Unfortunately, prednisolone is not very effective. Several studies, as well as meta‐analyses, suggest a modest improvement in 1‐month survival among patients receiving prednisolone. However, no study has shown an improvement in 3‐month or 6‐month survival with prednisolone treatment. The ineffectiveness of prednisolone in improving 3‐6–month survival

Journal

Liver TransplantationWiley

Published: Jan 1, 2018

References

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