Efficacy and Safety of Therapeutic Plasma Exchange vs Standard Medical Therapy in Severe Autoimmune Hepatitis.

* Study population: Patients presenting with severe autoimmune hepatitis and MELD\>24 with no liver transplant option. * Study design: A Pilot Randomised control trial * Study period: 2 year * Sample size: * There is no studies of PE in severe AIH, assuming effect of PE in ACLF group * Survival rate with plasma exchange was assumed to be 60 % and 20 % without PE. * Further assuming 95% power and alpha 5 %. * We need to enroll 46 cases i.e. 23 in each group * Further assuming % defaulter rate, it is further decided to enroll 25 cases in each group. * Patients will be randomly allocated in 2 groups by 1:1 block randomisation and will be implemented by IWRS facility taking block size 10. * Monitoring and assessment: All patients would undergo vital and baseline parameter screening before randomization. Based on randomization they will receive either steroid or plasma exchange followed by steroid. * Interim analysis would be done to check efficacy and safety of TPE in severe autoimmune hepatitis. * Adverse effects: Therapeutic Plasma Exchange is associated with risk of adverse events like infections,Fluid overload or circulatory insufficiency, Hypersensitivity to blood products. \- Stopping rule: Study will be stopped in case of life- threatening events occur in patient after randomisation