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


CONCLUSIONS
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.
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.
Keiichi
K
Fujiwara
Shin
S
Yasui
Akinobu
A
Tawada
Koichiro
K
Okitsu
Yutaka
Y
Yonemitsu
Tetsuhiro
T
Chiba
Makoto
M
Arai
Tatsuo
T
Kanda
Fumio
F
Imazeki
Masayuki
M
Nakano
Shigeto
S
Oda
Osamu
O
Yokosuka