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

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 autoimm...

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Published in:Journal of hepato-biliary-pancreatic sciences 2016-04, Vol.23 (4), p.212-219
Main Authors: Fujiwara, Keiichi, Yasui, Shin, Yonemitsu, Yutaka, Arai, Makoto, Kanda, Tatsuo, Fukuda, Yoshihiro, Nakano, Masayuki, Oda, Shigeto, Yokosuka, Osamu
Format: Article
Language:English
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
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Summary: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 
ISSN:1868-6974
1868-6982
DOI:10.1002/jhbp.326