Etiology and outcome of acute liver failure: retrospective analysis of 50 patients treated at a single center.
OBJECTIVE
Acute liver failure (ALF) remains a devastating disease carrying considerable mortality. Since deceased donor liver transplantation is rarely performed in Japan, the artificial liver support system (ALS) and living donor liver transplantation (LDLT) are the main modalities used for treatment of ALF. The aim of this study was to analyze the outcome of ALF patients and to evaluate therapies for ALF according to etiology.


METHODS
Fifty consecutive patients with ALF were treated between January 1990 and December 2006. Prior to 1997, patients received ALS only. After 1997, ALS and/or LDLT were applied. LDLT was performed in 10 patients.


RESULTS
Four of 15 (27%) pre-1997 ALF patients survived, and 16 of 35 (46%) post-1997 ALF patients survived, including eight who underwent LDLT. The causes of ALF were acute hepatitis B virus (HBV) infection in 18%, severe acute exacerbation (SAE) of chronic HBV infection in 18%, autoimmune hepatitis (AIH) in 8%, and cryptogenic hepatitis in 44%. In total, 67% of the patients with ALF caused by acute HBV infection and AIH were cured without LDLT; only 11% of patients with ALF caused by SAE of HBV and 24% of cryptogenic hepatitis were successfully treated without LDLT. Notably, 80% of patients with cryptogenic hepatitis who underwent LDLT survived.


CONCLUSIONS
Since 1997, the survival rate of ALF patients has increased, mainly due to the introduction of LDLT. Liver transplantation should be performed especially in patients with ALF caused by SAE of HBV and cryptogenic hepatitis.
Hiramatsu
Akira
A
Department of Medicine and Molecular Science, Hiroshima University, Hiroshima, Japan.
Takahashi
Shoichi
S
Aikata
Hiroshi
H
Azakami
Takahiro
T
Katamura
Yoshio
Y
Kawaoka
Tomokazu
T
Uka
Kiminori
K
Yamashina
Keitaro
K
Takaki
Shintaro
S
Kodama
Hideaki
H
Jeong
Soo Cheol
SC
Imamura
Michio
M
Kawakami
Yoshiiku
Y
Chayama
Kazuaki
K
D000328:Adult; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000209:etiology* / Q000628:therapy*; D016031:Liver Transplantation; D019164:Liver, Artificial; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome