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Re-evaluation of the Guideline published by the Acute Liver Failure Study Group of Japan in 1996 to determine the indications of liver transplantation in patients with fulminant hepatitis

Analysis of 698 patients seen between 1998 and 2003 enrolled in the annual nationwide survey conducted by the Intractable Liver Diseases Study Group of Japan

Authors

  • Satoshi Mochida,

    Corresponding author
    1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Saitama Medical University, Saitama, and
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  • Nobuaki Nakayama,

    1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Saitama Medical University, Saitama, and
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  • Atsushi Matsui,

    1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Saitama Medical University, Saitama, and
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  • Sumiko Nagoshi,

    1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Saitama Medical University, Saitama, and
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  • Kenji Fujiwara

    1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Saitama Medical University, Saitama, and
    2. Yokohama Rosai Hospital, Yokohama, Japan.
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Prof Satoshi Mochida, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-cho, Iruma-gun, Saitama 350-0495, Japan. Email: smochida@saitama-med.ac.jp

Abstract

Aim:  The indications for liver transplantation in cases of fulminant hepatitis are currently determined according to the Guideline of the Acute Liver Failure Study Group of Japan in 1996, which is based on assessment of the prognosis of the patients at the onset of hepatic encephalopathy and reassessed 5 days later. This Guideline was prepared based on the clinical findings in patients seen between 1988 and 1992, and showed a predictive accuracy of 82% in the patients seen between 1993 and 1995. In this study, the usefulness of the Guideline was re-evaluated, since the therapeutic strategies for fulminant hepatitis have advanced remarkably over the last 10 years.

Methods:  The predictive accuracy of the Guideline was assessed in 698 patients with fulminant hepatitis and late onset hepatic failure (LOHF) between 1998 and 2003. The time-point in the course of the disease at which physicians considered liver transplantation was examined.

Results:  The accuracy in patients not receiving liver transplantation was 68% and 78% in acute and subacute types, respectively, of fulminant hepatitis, and 84% among LOHF cases. The values did not improve following the reassessment. The sensitivity and specificity of the assessment in patients with acute and subacute types, respectively, were extremely low. Liver transplantation was considered in 42% of LOHF patients at 8 or more days before encephalopathy development.

Conclusion:  The Guideline should be modified to improve its accuracy. The Guideline should also be made adoptable for the assessment of LOHF patients before hepatic encephalopathy onset.

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