Early Intervention Based on a Prediction Formula Could Be Effective in Avoiding Unnecessary Transplantation.

Abstract

Purpose Fulminant hepatitis is a fatal syndrome requiring urgent attention and is assigned high priority for organ allocation. Therefore, the waiting list for liver transplantation is sometimes disturbed. Organ donor shortage is serious problem worldwide, especially in Japan. However, the recent revisions in the law regarding organ transplant seem to have had little impact on this problem. Therefore, we established a prediction formula for the development of fulminant hepatitis during the acute severe hepatitis. In the present study, we evaluated the effect of this prediction system and early intervention on patient survival without liver transplantation. Patients and method Between 2002 and 2014, 159 patients were admitted to our hospital because of acute severe hepatitis with a prothrombin time of less than 60%. One hundred twenty-two patients were admitted before the revision of the organ transplant law (2002-2009). Of these, 46 had fulminant hepatitis and 76 had acute severe hepatitis (36 with positive predictions for fulminant hepatitis and 40 with negative predictions). The remaining 37 of the total 159 patients were admitted after the revision of the organ transplant law (2010-2014). Of these, 21 had fulminant hepatitis at admission and 16 had acute severe hepatitis (12 with positive predictions and 4 with negative predictions). Patients were placed on an artificial liver support system comprising plasma exchange and hemodiafiltration, using a large volume of buffer immediately after the development of hepatic coma. The underlying disease was treated with a combination of immunosuppressive therapy and/or antiviral agents. Results In the 2002-2009 period, 30 of 46 patients with fulminant hepatitis at admission were alive. Of the 36 patients with positive predictions, 14 developed fulminant hepatitis and 32 were alive. Of the 40 patients with negative predictions, 4 developed fulminant hepatitis and 39 were alive. During the 8-year period, five patients underwent living donor liver transplantation, and three of the five patients were alive. In the 2010-20014 period, 14 of 21 patients with fulminant hepatitis at admission were alive. Of 12 patients with positive predictions, 8 developed fulminant hepatitis and 11 were alive under intensive medical care. All 4 patients with negative predictions were alive. Conclusion Use of the prediction formula and early intervention could be helpful in avoiding unnecessary transplantation.