INTERFERON AND CYCLOSPORINE-A IN THE TREATMENT OF FULMINANT VIRAL-HEPATITIS

The prognosis of fulminant hepatitis due to non-A, non-B virus infecti on and acute reactivation of hepatitis B virus in HE carriers is gener ally poor, and the treatment of choice in Western countries is recogni zed as liver transplantation. In countries such as Japan where liver t ransplantation is not readily available, however, these intractable ty pes of fulminant hepatitis have to be treated medically. Based on the assumption that persistent replication of causal viruses and enhanced host immune responses, especially cellular immunity, to eradicate the viruses are the key mechanism in progressive liver cell destruction an d the poor prognosis, we attempted a combination treatment with interf eron and cyclosporin A for these types of fulminant viral hepatitis. S ubjects in the present study consisted of 1 patient with acute severe hepatitis without coma and 13 patients with coma (13 with fulminant he patic failure) due to non-A, non-B virus and acute reactivation of hep atitis B virus. The patients were given interferon-beta, 300 x 10(4) d aily, and cyclosporin A, at an initial dose of 3 mg/kg, with tapering. Fourteen patients with coma received artificial liver support that we devised. The patient with acute severe hepatitis survived, showing hi stologically remarkable liver regeneration. Eight of the 14 patients w ith hepatic coma, all of whom were indications for liver transplantati on according to the criteria of the King's College group, survived. De creased transaminase level, increased liver volume, and histological l iver regeneration were observed in all the survivors. The combination of interferon and cyclosporin A is worth attempting in fulminant hepat itis caused by non-A, non-B virus and acute reactivation of hepatitis B virus in HE carriers.