Article first published online: 28 NOV 2006
Copyright © 2006 American Association for the Study of Liver Diseases
Volume 44, Issue 6, pages 1589–1597, December 2006
How to Cite
Taylor, R. M., Davern, T., Munoz, S., Han, S.-H., McGuire, B., Larson, A. M., Hynan, L., Lee, W. M. and Fontana, R. J. (2006), Fulminant hepatitis A virus infection in the United States: Incidence, prognosis, and outcomes. Hepatology, 44: 1589–1597. doi: 10.1002/hep.21439
See Editorial on Page 1397
Potential conflict of interest: Nothing to report.
The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
- Issue published online: 28 NOV 2006
- Article first published online: 28 NOV 2006
- Manuscript Accepted: 21 AUG 2006
- Manuscript Received: 7 JUN 2006
- National Institute of Diabetes and Digestive and Kidney Diseases. Grant Number: RO1- DK58369
- Jean Roberts and the Rollin and Mary Ella King Funds at the Southwestern Medical Foundation, Dallas
- Health Resources and Services Administration. Grant Number: 231-00-0115
Acute liver failure (ALF) due to hepatitis A virus (HAV) infection is an uncommon but potentially lethal illness. The aim of this study was to identify readily available laboratory and clinical features associated with a poor prognosis among ALF patients with HAV infection. The presenting features of 29 adults with anti-HAV IgM positive ALF enrolled in the ALFSG_between 1998 and 2005 were reviewed. The HAV patients listed for transplantation by UNOS were also reviewed. Acute HAV accounted for 3.1% of patients enrolled in the ALFSG. At 3 weeks follow-up, 16 had spontaneously recovered (55%), 9 underwent transplantation (31%), and 4 had died (14%). A prognostic model incorporating 4 presenting features (serum ALT <2,600 IU/L, creatinine >2.0 mg/dL, intubation, pressors) had an AUROC for transplant/death of 0.899 which was significantly better than the King's College criteria (0.623, P = .018) and MELD scores (0.707, P = .0503). Between 1988 and 2005, the frequency of patients requiring liver transplantation for HAV in the UNOS database significantly decreased from 0.7 % to 0.1% (P < .001). In addition, the proportion of HAV cases enrolled in the ALFSG significantly decreased from 5% to 0.8% (P = .007). In conclusion, the frequency of HAV patients enrolling in the ALFSG and being listed for liver transplantation in the United States has declined in parallel. A prognostic index consisting of 4 clinical and laboratory features predicted the likelihood of transplant/death significantly better than other published models suggesting that disease specific prognostic models may be of value in non-acetaminophen ALF. (HEPATOLOGY 2006;44:1589–1597.)