Infectious complications and timing for liver transplantation in autoimmune acute liver failure in Japan: a subanalysis
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ORIGINAL ARTICLE—LIVER, PANCREAS, AND BILIARY TRACT
Infectious complications and timing for liver transplantation in autoimmune acute liver failure in Japan: a subanalysis based on nationwide surveys between 2010 and 2015 Keiichi Fujiwara1,2 • Nobuaki Nakayama3 • Naoya Kato1 • Osamu Yokosuka1 • Hirohito Tsubouchi4 • Hajime Takikawa5 • Satoshi Mochida3 • the Intractable Hepato-Biliary Diseases Study Group of Japan6
Received: 26 March 2020 / Accepted: 8 June 2020 Ó Japanese Society of Gastroenterology 2020
Abstract Background The prognosis of autoimmune acute liver failure (ALF) without liver transplantation (LT) is poor worldwide. We subanalyzed infectious complications of autoimmune ALF using data of nationwide surveys between 2010 and 2015 retrospectively and tried to determine when to evaluate the efficacy of corticosteroid (CS) treatment or abandon it for LT based on objective data. Methods One hundred and forty-four patients with autoimmune ALF, comprising 79 ALF with coma B I, 52 ALF with coma C II and 13 late onset hepatic failure (LOHF), were analyzed. Results CS was administered to 140 (97%) patients. Thirty-seven (26%) patients had infectious complications. Patients with infection revealed more advanced disease type (p \ 0.001) and poorer spontaneous survival Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00535-020-01699-3) contains supplementary material, which is available to authorized users. & Keiichi Fujiwara [email protected] 1
Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
2
Faculty of Healthcare Sciences, Chiba Prefectural University of Health Sciences, Chiba, Japan
3
Department of Gastroenterology and Hepatology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
4
Kagoshima City Hospital, Kagoshima, Japan
5
Faculty of Medical Technology, Teikyo University, Tokyo, Japan
6
The Ministry of Health, Labor and Welfare of Japan, Tokyo, Japan
(p \ 0.001) than those without infection. Median (interquartile range) duration between diagnosis of ALF and onset of infection was 18.5 (11–36) days, and that between introduction of CS and onset of infection was 17 (10.5–36) days. Seventy-nine (55%) recovered without LT, 14 (10%) received LT and 51 (35%) died without LT. Dead or transplanted patients were older (p = 0.0057), and revealed more advanced liver failure (p \ 0.001) and more occurrence of infection (p \ 0.001). Conclusions A critical point for evaluating the efficacy of CS treatment and switching to LT is at most 2-week after diagnosis of ALF and introduction of CS. More important, we should accelerate the point and prepare for LT in cases of ALF with coma C II and LOHF, and we should have performed LT by then at the latest in case of failure to improve. Keywords Autoimmune hepatitis Acute liver failure Corticosteroid Liver transplantation Infection Abbreviations AIH Autoimmune hepatitis ALF Acute liver failure LOHF Late onset hepatic failure CS C
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