Abstract
BACKGROUND AND AIMS: Prolonged cholestasis after acute viral hepatitis (AVH) complicates <1% of patients. The treatment includes the use of anti-pruritic medications in a stepwise manner. This study assessed the role of Plasma exchange (PLEX) with corticosteroids on severe prolonged cholestasis. METHODS: Retrospective analysis of patients with AVH and prolonged cholestasis was conducted. Prolonged cholestasis was defined as jaundice for >6 weeks with peak serum bilirubin >10 mg/dL, in the absence of haemolysis and renal failure with alanine transferase level below 500U/L. A combination of centrifugal PLEX with corticosteroids was offered if there was no response to anti-pruritic medications. A control group, which received only anti-pruritic medications, was included for comparison. RESULTS: Fifty-nine patients, predominantly males (90%; n = 53) were included. Most common etiology was HAV (n = 56; 94.9%) followed by HEV (n = 3; 5.1%). Despite more severe disease, (higher Visual Analogue Scale (VAS) - 9 [9-9] vs 8 [7-8], P < 0.001 and higher bilirubin - 30.6 ± 4.1 vs 27.3 ± 7.1 mg/dL, P = 0.03), bilirubin reduction was faster in combination group. Percentage reduction in bilirubin at week 1 and week 4 was 43.6% ± 7.9% and 93.8% ± 1.6% in the combination group vs 37.9% ± 12.9% and 89.4% ± 4.4% in the conservative group (P = 0.04 and < 0.001, respectively). Median time to symptom improvement was less in the combination group (25 [22-27] days vs 42 [38-48] days; P < 0.001 in conservative group). CONCLUSION: PLEX combined with low-dose oral steroids results in significant improvement in prolonged cholestasis and can be considered as an effective rescue therapy in patients who do not respond to standard anti-pruritic medications.