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Infectious complications and timing for liver transplantation in autoimmune acute liver failure in Japan: a subanalysis based on nationwide surveys between 2010 and 2015

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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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 ≤ I, 52 ALF with coma ≥ 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 (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 ≥ II and LOHF, and we should have performed LT by then at the latest in case of failure to improve.

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Abbreviations

AIH:

Autoimmune hepatitis

ALF:

Acute liver failure

LOHF:

Late onset hepatic failure

CS:

Corticosteroid

LT:

Liver transplantation

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Acknowledgements

We thank doctors for their cooperation to enroll patients (Supplementary Table 1). This study was performed with the support of the Ministry of Health, Labour and Welfare as an official project by the Intractable Hepato-Biliary Diseases Study Group of Japan.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Japan

    Keiichi Fujiwara, Naoya Kato & Osamu Yokosuka

  2. Faculty of Healthcare Sciences, Chiba Prefectural University of Health Sciences, Chiba, Japan

    Keiichi Fujiwara

  3. Department of Gastroenterology and Hepatology, Faculty of Medicine, Saitama Medical University, Saitama, Japan

    Nobuaki Nakayama & Satoshi Mochida

  4. Kagoshima City Hospital, Kagoshima, Japan

    Hirohito Tsubouchi

  5. Faculty of Medical Technology, Teikyo University, Tokyo, Japan

    Hajime Takikawa

Authors
  1. Keiichi Fujiwara
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  2. Nobuaki Nakayama
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  3. Naoya Kato
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  4. Osamu Yokosuka
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  5. Hirohito Tsubouchi
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Consortia

the Intractable Hepato-Biliary Diseases Study Group of Japan

Contributions

All authors participated in the interpretation of study results, and in the drafting, critical revision, and approval of the final version of the manuscript. All are members of the Intractable Hepato-Biliary Diseases Study Group of Japan. NN and SM performed annual nationwide surveys and constructed the original database as official projects by the Intractable Hepato-Biliary Diseases Study Group of Japan. KF was involved in the data collection, extracted the data of autoimmune acute liver failure from the original database, analyzed data and wrote the manuscript. NK and OY were involved in the data collection and are co-workers of KF in the Study Group. Hirohito Tsubouchi was involved in the data collection and is the former Chair of the Intractable Hepato-Biliary Diseases Study Group of Japan, and Hajime Takikawa was involved in the data collection and is the present Chair of the Intractable Hepato-Biliary Diseases Study Group of Japan. SM was investigator in the study, involved in the data collection and is the Chair of the Fulminant Hepatitis Study Group, subgroup of the Intractable Hepato-Biliary Diseases Study Group of Japan.

Corresponding author

Correspondence to Keiichi Fujiwara.

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Conflicts of interest

Satoshi Mochida received lecture fees from Abbvie GK, Gilead Sciences Inc., MSD K.K., Ohtsuka Parmaceutical Co. Ltd., Bristol-Myers Squibb Co., Dainihon-Sumitomo Pharma Co. Ltd., Asuka Pharmaceutical Co. Ltd., Torey Medical, Asahikasei Pharma Co., Kyowa Hakko Kirin Co. Ltd., consigned/joint research expenses from Gilead Sciences Inc., EA Pharma Co., Ltd., Janssen Pharmaceutical K.K., Kowa Co. Ltd., MSD K.K., Abbvie GK, and scholarship donations from Abbvie GK, MSD K.K., Dainihon-Sumitomo Pharma Co. Ltd., Mochida Pharmaceutical Co. Ltd., Daiich Sankyo Co. Ltd., Torey Medical, Chugai Pharmaceutical Co., SRL inc., EA Pharma Co., Ltd., Japan Blood Products Organization. The other authors declare that they have no conflict of interest.

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Fujiwara, K., Nakayama, N., Kato, N. et al. Infectious complications and timing for liver transplantation in autoimmune acute liver failure in Japan: a subanalysis based on nationwide surveys between 2010 and 2015. J Gastroenterol 55, 888–898 (2020). https://doi.org/10.1007/s00535-020-01699-3

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  • DOI: https://doi.org/10.1007/s00535-020-01699-3

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