A multicenter study on the prognosis of fulminant viral hepatitis: Early prediction for liver transplantation

Takahashi, Y; Kumada, Hiromitsu; Shimizu, Masaru; Tanikawa, Kyuichi; Kumashiro, Ryukichi; Omata, Masao; Ehata, Toshiki; Tsuji, Takao; Ukida, Minoru; Yasunaga, Mitsuru; Okita, Kiwamu; Sato, Shunichi; Takeuchi, Toshihiko; Tsukada, Katsuhiko; Obata, Hiroshi; Hashimoto, Etsuko; Ohta, Yasuyuki; Tada, Kouji; Kosaka, Yoshitane; Takase, Koujiro; Yoshiba, Makoto; Sekiyama, Kazuhiko; Kaburagi, Takashi; Mizoguchi, Yasuhiro

doi:10.1002/hep.1840190502

Cited by 50 publications

(31 citation statements)

References 30 publications

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“…The importance of age as a prognostic factor for fulminant hepatitis B has been reported previously (2,13,20 …”

Section: T a B L E 2 -B F A C T O R S As S O C I A T E D Wi T H F Amentioning

confidence: 76%

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Lamivudine Treatment Improves the Prognosis of Fulminant Hepatitis B

et al. 2008

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“…The importance of age as a prognostic factor for fulminant hepatitis B has been reported previously (2,13,20 …”

Section: T a B L E 2 -B F A C T O R S As S O C I A T E D Wi T H F Amentioning

confidence: 76%

“…Tillmann et al (6) (8,9). Genotypes affect clinical features of acute hepatitis B virus infection (10,11 (2,13). Recently, we reported the importance of systemic inflammatory response syndrome as a prognostic factor for fulminant hepatic failure (14).…”

Section: Worldwide Hepatitis B Virus Infection Is One Of the Most Frmentioning

confidence: 98%

Lamivudine Treatment Improves the Prognosis of Fulminant Hepatitis B

et al. 2008

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“…These treatments have resulted in a survival rate of 30%. 12 They have also modified the pathological features of FHF and SFHF of our patients, and they differ from those seen in the United States and European countries. Patients with FHF or SFHF who had received intensive care to prolong survival but who failed to wean from plasmapheresis were included in this study.…”

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confidence: 99%

Living-related liver transplantation for patients with fulminant and subfulminant hepatic failure

et al. 1999

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The prognosis for patients with fulminant (FHF) or subfulminant hepatic failure (SFHF) has improved since the introduction of liver transplantation. However, the death rate of patients awaiting liver transplantation is high, possibly because of the difficulty in obtaining grafts in a timely manner, given the relative shortage of cadaveric donors. Between June 1990 and June 1999, 106 patients underwent living-related liver transplantation (LRLT) at Shinshu University Hospital. Among them, 8 patients had FHF and 6 had SFHF; these 14 patients are the subjects of this report. The graft volumes (GV) ranged from 231 mL to 625 mL, corresponding to 35% to 105% of the recipients' standard liver volume (SLV). The postoperative courses of all donors were uneventful. Following liver transplantation, all grafts functioned favorably, with normalization of serum total bilirubin within 3 to 5 days and normalization of coagulation profiles within 4 to 7 days. Thirteen of the 14 recipients are still alive. The actuarial 6-month, 1-year, and 5-year survival rates were 100%, 90%, and 90%, respectively. In the present study, when the ratio of the GV to the recipient's SLV was more than 35%, the graft was able to support the patient's metabolic demand after liver transplantation for FHF or SFHF. Because of the urgent nature of liver transplantation in this clinical condition, concerns over informed consent may be even greater than for elective LRLT. Nevertheless, the high success rate and low donor risk may justify this option for pediatric patients, as well as for a limited population of adult patients suffering from FHF or SFHF. (HEPATOLOGY 1999;30:1521-1526.)The prognosis for patients with fulminant hepatic failure (FHF) and subfulminant hepatic failure (SFHF) has improved since the introduction of orthotopic liver transplantation. 1 The survival rate of patients with these conditions who undergo liver transplantation is in the range of 56% to 80%, 2-4 compared with the 15% to 20% survival rate of patients who do not undergo transplantation, even with improved medical treatment. 5 Because FHF is rapidly progressive and irreversible, the need for liver transplantation is urgent. The death rate of patients awaiting liver transplantation is as high as 40% 6 or 62%, 7 possibly as a result of the difficulty of obtaining grafts in a timely manner, given the relative shortage of cadaveric donors.Living-related liver transplantation (LRLT) has been developed as an alternative to cadaveric liver transplantation. To avoid ethical dilemmas in LRLT, including any potential coercion of the live donor candidates, we have pursued a strict policy of ensuring that the participants in LRLT are fully informed of all aspects and risks of the procedure before we obtain their consent. As favorable results for LRLT have accumulated, reluctance toward the procedure has gradually subsided. Given this success, it is worth considering LRLT for patients with FHF, provided that each situation is considered with special care because of the short amount of time...

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“…14,15 Emergent orthotopic liver transplantation has therefore become the treatment of choice for patients who are not expected to recover. [17][18][19] However, because of the lack of immediate availability of donor organs, other treatment options are needed.…”

confidence: 99%

Treatment of fulminant hepatic failure with intravenous prostaglandin E1

et al. 1998

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Fulminant hepatic failure (FHF) is a severe, lifethreatening disorder. Previous studies have suggested that intravenous prostaglandin treatment may improve survival in FHF. The present study was performed to further investigate the possible benefit of intravenous prostaglandin E 1 (PGE 1 ) for patients with FHF. A total of 18 patients, all excluded as candidates for hepatic transplantation, were studied. Thirteen of 18 participated in a randomized, double-blind, placebo-controlled trial. PGE 1 was administered by continuous infusion at a dose of 10 to 40 g/h as tolerated. After 48 hours of blinded treatment, 3 of 7 patients randomized to placebo were converted to open-label PGE 1 for lack of biochemical and/or clinical improvement. Mean values for alanine transaminase, aspartate transaminase, total bilirubin, prothrombin time, factor V percent, factor VII percent, hepatic encephalopathy score, days from onset of symptoms to initiation of treatment, and cause of FHF were similar between treatment groups. Ten of 18 patients (55%) enrolled in this trial survived. However, survival was not different between PGE 1 -(60%) and placebo (50%) treated patients. The greatest predictor of survival was the number of days from onset of symptoms to hospitalization, which was significantly (P ‫؍‬ .002) shorter for survivors (3.3 v 12.4 days), regardless of PGE 1 treatment. Six of 8 patients (75%) who began PGE 1 therapy and 4 of 5 placebo-treated patients (80%) hospitalized within 10 days of onset of symptoms survived. By contrast, all 5 patients who were hospitalized and subsequently began PGE 1 treatment 10 days or longer after the onset of symptoms died. We conclude that early recognition and hospitalization is the most important factor in reduction of mortality from FHF. It is unclear whether PGE 1 treatment is beneficial when administered during this period. However, it is apparent that PGE 1 was not effective for treatment of FHF if treatment started more than 10 days after onset of this clinical syndrome.

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A multicenter study on the prognosis of fulminant viral hepatitis: Early prediction for liver transplantation

Cited by 50 publications

References 30 publications

Lamivudine Treatment Improves the Prognosis of Fulminant Hepatitis B

Lamivudine Treatment Improves the Prognosis of Fulminant Hepatitis B

Living-related liver transplantation for patients with fulminant and subfulminant hepatic failure

Treatment of fulminant hepatic failure with intravenous prostaglandin E1

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