Treatment of intractable intrahepatic cholestasis with plasmapheresis.

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The treatment with plasmapheresis was applied to four patients with intractable intrahepatic cholestasis, in whom common conservative treatments including corticosteroid were ineffective. Mean plasma volume and mean time required for exchange were 3100ml and 196 minutes, respectively. In a case of drug-induced cholestasis and a case of alcoholic hepatitis with positive HBsAg, plasma exchange led to gradual decrease in serum bilirubin at its first attempt with resultant normalization during two months. In a case of PBC with postoperative jaundice serum bilirubin decreased from 15mg/dl to 8mg/dl after the first attempt, and from 8mg/dl to 5mg/dl after the second attempt. In a case of subacute hepatitis, however, the first treatment led to decrease in serum bilirubin from 35mg/dl to 25mg/dl, though the patient died two days after the second procedure. These results suggest that the treatment with plasmapheresis may be effective for reduction of serum bilirubin in patients with intractable intrahepatic cholestasis.