Indication criteria for liver transplantation for acute liver failure in Japan

Abstract

In Japan, patients with hepatitis are diagnosed as having fulminant hepatitis and late-onset hepatic failure (LOHF) when grade II or more severe hepatic encephalopathy develops within 8 weeks and between 8 and 24 weeks, respectively, of the disease onset, with a prothrombin time of less than 40% of the standardized value. Fulminant hepatitis patients are classified into the acute and subacute types, in which the encephalopathy occurs within 10 days and later than 11 days, respectively. According to the nation-wide survey by the Intractable Liver Disease Study Group of Japan, liver transplantation was performed in 14% and 26% of the patients with the acute and subacute types, respectively, and in 19% with LOHF between 1998 and 2003. Survival rate of these patients was 77%, which was greater than those of the patients treated without liver transplantation; 54%, 24% and 12% in the acute and subacute types and LOHF, respectively. The indications for liver transplantation in fulminant hepatitis patients 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. Predictive accuracy of the Guideline, assessed in the patients between 1998 and 2003, were 68% and 78% among the cases with the acute and subacute types, respectively, of fulminant hepatitis. Liver transplantation was considered in most of LOHF patients at 8 or more days before encephalopathy development. Although liver transplantation improved the prognosis of patients with acute liver failure, the Guideline should be modified to improve the accuracy for fulminant hepatitis patients, and the new criteria should be made for LOHF patients.