Analysis of the safety of pretransplant corticosteroid therapy in patients with acute liver failure and late‐onset hepatic failure in Japan

• Published in: JGH open 2021-04, Vol.5 (4), p.428-433
• Main Authors: Hisanaga, Takuro, Hidaka, Isao, Sakaida, Isao, Nakayama, Nobuaki, Ido, Akio, Kato, Naoya, Takikawa, Yasuhiro, Inoue, Kazuaki, Shimizu, Masahito, Genda, Takuya, Terai, Shuji, Tsubouchi, Hirohito, Takikawa, Hajime, Mochida, Satoshi, Intractable Hepato‐Biliary Disease Study Group of Japan
• Format: Article
• Language: English
• Subjects: acute liver failure; Age; Coma; corticosteroid; Disease; Drug overdose; Etiology; Gender; Hepatitis; Infections; late‐onset hepatic failure; liver transplantation; Liver transplants; Mortality; Original
• ISSN: 2397-9070; 2397-9070
• DOI: 10.1002/jgh3.12508

Background and Aim In Japan, corticosteroids have been commonly used as a part of multidisciplinary therapy for patients with acute liver failure and late‐onset hepatic failure. However, there is controversy regarding the development of infections and other complications. In this study, the influence of corticosteroids on patient outcomes after liver transplantation was investigated. Methods This study included 167 patients with acute liver failure and late‐onset hepatic failure who underwent liver transplantation between 2010 and 2015. The effects of pretransplant corticosteroid therapy on patient outcomes were evaluated using a database constructed by the subcommittee for fulminant hepatitis in the Intractable Hepato‐Biliary Diseases Study Group of Japan. Results The subacute type and the median total bilirubin levels were higher in those receiving corticosteroids than in those not receiving corticosteroids. Although infections tended to be higher in patients receiving corticosteroids, pretransplant corticosteroid administration did not affect the survival rates. The duration from corticosteroid initiation to liver transplantation was longer in patients who developed infections. The survival rates, however, did not differ between patients with and without infections. Conclusions Corticosteroids were administered to patients with poor prognoses. Otherwise, the overall outcome in those administered corticosteroids was not significantly different from that in those administered without corticosteroids. Although infectious complications tended to occur, they were generally controllable and nonfatal. Pretransplant corticosteroid therapy may be permissible, with regarding for infections and performed within the minimum duration. Corticosteroids are commonly used for acute liver failure in Japan. However, there is controversy regarding the development of complications. We analyzed the influence of corticosteroids on patient outcomes after liver transplantation. Although, infections tended to occur in patients receiving corticosteroids, pretransplant corticosteroid didn't affect the survival rates. The duration from corticosteroid initiation to liver transplantation was longer in patients with infections. Pretransplant corticosteroid may be a permissible treatment with caution for infections and within the minimum duration.