Autoimmune fulminant liver failure in adults: Experience in a Japanese center

Keiichi Fujiwara; Shin Yasui; Akinobu Tawada; Koichiro Okitsu; Yutaka Yonemitsu; Tetsuhiro Chiba; Makoto Arai; Tatsuo Kanda; Fumio Imazeki; Masayuki Nakano; Shigeto Oda; Osamu Yokosuka

doi:10.1111/j.1872-034X.2010.00755.x

Autoimmune fulminant liver failure in adults: Experience in a Japanese center

Hepatol Res. 2011 Feb;41(2):133-41. doi: 10.1111/j.1872-034X.2010.00755.x.

Authors

Keiichi Fujiwara¹, Shin Yasui, Akinobu Tawada, Koichiro Okitsu, Yutaka Yonemitsu, Tetsuhiro Chiba, Makoto Arai, Tatsuo Kanda, Fumio Imazeki, Masayuki Nakano, Shigeto Oda, Osamu Yokosuka

Affiliation

¹ Departments of Medicine and Clinical Oncology and Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, and Department of Pathology, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan.

PMID: 21269383
DOI: 10.1111/j.1872-034X.2010.00755.x

Abstract

Aim: After the establishment of the international criteria of autoimmune hepatitis (AIH) in 1999 and the recognition of acute onset AIH, the diagnosis of patients with fulminant type of AIH came to be made. We diagnosed autoimmune fulminant liver failure based on the criteria, and discussed the etiology of fulminant hepatitis (FH) and late onset hepatic failure (LOHF), and the characteristics of autoimmune fulminant liver failure.

Methods: We investigated the etiology of 95 consecutive adult patients with FH or LOHF admitted to our liver unit between 1990 and 2009. Clinical and biochemical features, therapies and outcomes were examined in patients with AIH after 2000.

Results: Of 95 patients, 85 were FH and 10 LOHF. The etiology was due to viral infections in 51.6% (hepatitis A virus in 7.4%, hepatitis B virus in 43.2% and hepatitis E virus in 1.1%), AIH in 15.8%, drug allergy-induced in 12.6%, and unknown causes in 20.0%. The rate of patients with AIH increased significantly between 2000 and 2009 compared to the rate between 1990 and 1999 (P = 0.002). In recovered patients with AIH without transplantation after 2000, coma grade was lower, alanine aminotransferase level, prothrombin time activity and alfa-fetoprotein level were higher than in the others with statistical significance.

Conclusion: AIH is not a rare cause of FH and LOHF, and the number of patients with unknown causes would surely decrease in concert with the precise diagnosis of AIH.