T1954 Originally Developed Intensive Medical Care for Fulminant Hepatic Failure Improved Patients' Survival Rate and Also Safely Bridge Fatal Patients to Liver Transplantation

Abstract

Aim Patients with subacute fulminant hepatic failure (FHF) and late-onset hepatic failure (LOHF) show relatively slow disease progression, although usually suffer serious liver damage. It therefore seems that liver can lose its regenerative capability at the appearance of hepatic coma. No effective treatments have been established for such cases. We advocated that predicting the development of FHF at the stage of severe hepatitis and early intervention with intensive medical treatment for the underlying liver disease could improve the survival rate in these cases. The present study examined the efficacy of our proposed treatment system. Method Inclusion criteria of the present study were as follows: acute hepatitis patients admitted to Showa University Fujigaoka Hospital from 2002 to 2008, prothrombin time below 60% of normal, and absence of hepatic coma on admission. Prediction of FHF was determined based on a previously reported formula (Yoshiba M, J Gastro 2002). Treatment for underlying hepatitis consisted mainly of immunosuppressive therapy using methylpredonisolone withdrawal in combination with continuous cyclosporin A infusion and/or antiviral therapy using interferon beta and/or nucleic acid analogues. Patients were also given artificial liver support immediately after the appearance of hepatic coma; it comprised plasma exchange in combination with hemodiafiltration using huge buffer volumes. Results The inclusion criteria were met by 74 patients with causes of hepatitis listed as HAV (3), HBV (11), HBV carrier (23), HCV (8), drugs (1), and indeterminate (28). Of the total, 34 patients were positive for the prediction formula. Probability of the development of FHF and estimated survival rate were 84% and 40%, respectively. Thirteen of the 34 patients developed FHF with 10 surviving, and 30 of the 34 patients survived (survival rate, 88%). Of the remaining 40 patients who were negative for the prediction formula, 4 developed FHFwith all surviving, and 39 of the 40 patients survived overall (survival rate, 97.5%). One patient died of malignant lymphoma. Conclusion Prediction of FHF and early intervention with intensive medical care are effective in preventing the development of FHF and improving survival rate without liver transplantation in patients with FHF.