Analysis of infectious complications and timing for emergency liver transplantation in autoimmune acute liver failure

• Published in: Journal of hepato-biliary-pancreatic sciences Vol. 23; no. 4; pp. 212 - 219
• Main Authors: Fujiwara, Keiichi, Yasui, Shin, Yonemitsu, Yutaka, Arai, Makoto, Kanda, Tatsuo, Fukuda, Yoshihiro, Nakano, Masayuki, Oda, Shigeto, Yokosuka, Osamu
• Format: Journal Article
• Language: English
• Published: Japan Blackwell Publishing Ltd 01.04.2016; Wiley Subscription Services, Inc
• Subjects: Autoimmune hepatitis; Emergencies; Female; Follow-Up Studies; Fulminant hepatitis; Hepatitis, Autoimmune - complications; Hepatitis, Autoimmune - surgery; Humans; Incidence; Infection; Japan - epidemiology; Liver Failure - etiology; Liver Failure - surgery; Liver Failure, Acute - surgery; Liver transplantation; Liver Transplantation - adverse effects; Male; Middle Aged; Retrospective Studies; Severe hepatitis; Surgical Wound Infection - epidemiology; Survival Rate - trends; Time Factors; Infection; Fulminant hepatitis; Autoimmune hepatitis; Severe hepatitis; Liver transplantation
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1002/jhbp.326

Background Autoimmune hepatitis (AIH) is one of major etiologies of acute liver failure (ALF), and the survival rate without liver transplantation (LT) of patients with fulminant AIH is especially poor worldwide. We investigated the clinicopathological features of infectious complications in autoimmune ALF retrospectively and tried to determine when to continue corticosteroid (CS) treatment or abandon it for LT. Methods Twenty patients with autoimmune ALF, comprising five severe hepatitis, 13 fulminant hepatitis and two late onset hepatic failure, were analyzed. Results Corticosteroids were administered to 19 patients. Seventeen infectious complications were observed in 12 patients. The median (range) duration between the introduction of CS and onset of infection was 15 (10–41) days. There were no significant differences in clinicobiochemical features between patients with and without infection. Of 20 patients, eight (40%) recovered without LT, four (20%) received LT and eight (40%) died without LT. Dead or transplanted patients had more advanced liver failure on admission than recovered ones (P < 0.01). Conclusions Two‐week after the introduction of CS is a critical point for avoiding infectious complications. Therefore, we should have evaluated efficacy of CS and performed LT by then at the latest in case of failure to improve. Highlight Fujiwara and colleagues reveal that the critical point for switching to liver transplantation without infectious complications in autoimmune acute liver failure is two weeks after the start of corticosteroid treatment. It is crucial to evaluate corticosteroid efficacy and, if no improvement is seen, to perform liver transplantation by that time.