Early Dynamics of MELD Scores Predict Corticosteroid Responsiveness to Severe Acute-Onset Autoimmune Hepatitis

Noguchi, Fumie; Chu, Po–Sung; Yoshida, Aya; Taniki, Nobuhito; Morikawa, Rei; Hasegawa, Yasushi; Yamataka, Karin; Hoshi, Hitomi; Kasuga, Ryosuke; Tabuchi, Takaya; Ebinuma, Hirotoshi; Shinoda, Masahiro; Obara, Hideaki; Kitagawa, Yuko; Kanai, Takanori; Nakamoto, Nobuhiro

doi:10.1016/j.cgh.2021.06.006

Cited by 7 publications

(1 citation statement)

References 8 publications

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“…The prevalence of acute hepatitis D virus infection is highest in Mongolia, where 8% of the general population and 83.3% of hepatitis B surface antigen (HBsAg)-positive patients are infected [22,23]. Other causes for ALF are pregnancy-related, autoimmune hepatitis (AIH), and Wilson's disease [24][25][26][27].…”

Section: Non-malignant Conditionsmentioning

confidence: 99%

Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation

Kim,

Yoon,

Kim

et al. 2024

Hepatol Int

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Liver transplantation is a highly complex and challenging field of clinical practice. Although it was originally developed in western countries, it has been further advanced in Asian countries through the use of living donor liver transplantation. This method of transplantation is the only available option in many countries in the Asia-Pacific region due to the lack of deceased organ donation. As a result of this clinical situation, there is a growing need for guidelines that are specific to the Asia-Pacific region. These guidelines provide comprehensive recommendations for evidence-based management throughout the entire process of liver transplantation, covering both deceased and living donor liver transplantation. In addition, the development of these guidelines has been a collaborative effort between medical professionals from various countries in the region. This has allowed for the inclusion of diverse perspectives and experiences, leading to a more comprehensive and effective set of guidelines. Keywords Living donor liver transplantation • Deceased donor liver transplantation • Multidisciplinary • GradeSpecial consideration: LDLT in ACLF In a study of 112 LDLT recipients with ACLF, defined by the APASL definition, post-LT outcomes were excellent (92.9% at 5 years) [69]. In a study on high-model end-stage liver disease (MELD) (score ≥ 30) LDLT recipients with ACLF (n = 190), defined by the World Congress of Gastroenterology [70], the 5-year survival rate was 72.1% [71]. In a study of 117 LDLT recipients who had ACLF, as defined by the EASL-CLIF definition, post-transplant survival after LDLT was 92.9%, 85.4%, and 75.6% at 1 year, while mortality rate without LT was 28.5%, 77.7%, and 93.4% at 90 days, for ACLF grades 1, 2, and 3, respectively [72]. These data indicate that LDLT can be a life-saving treatment option for patients with ACLF.LDLT differs significantly from DDLT, as the timing of LDLT can be determined by the transplant team. There are advantages and disadvantages of LDLT in the setting of ACLF. The benefit of LDLT in patients with ACLF is its ability to provide rapid transplantation to critically ill patients [73], without waiting for deceased donor allocation. The ideal time for LT can be selected by transplant team when willing living donor is available. If ideal time for LT can be selected in the dynamic course of ACLF, this may improve post-LT outcome. The disadvantages of LDLT include the need for healthy, willing liver donor, and the use of partial grafts for critically ill patients. A graft-to-recipient weight ratio (GRWR) is a factor associated with post-LT outcomes in LDLT [74]. The donor risk index is a factor associated with post-LT outcomes for patients with ACLF who received DDLT [66,75]. This indicates that DDLT, which uses whole liver grafts, might be a better compared to LDLT, which uses partial grafts, in ACLF. In addition, there are uncertainties regarding the criteria for living donor graft quality that is required for critically ill patients with ACLF. In studies that reported...

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Section: Non-malignant Conditionsmentioning

confidence: 99%

Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation

Kim,

Yoon,

Kim

et al. 2024

Hepatol Int

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Outcomes of patients with acute severe autoimmune hepatitis: Predictors of non‐response to corticosteroids and need for liver transplantation

Eshraghian,

Taghavi,

Nikeghbalian

2024

UEG Journal

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Background and AimsAcute severe autoimmune hepatitis (AS‐AIH) is an evolving concept and the outcomes and optimal treatment have been less studied. In this study, we aimed to investigate the outcomes of patients with AS‐AIH and predictors of non‐response to corticosteroid therapy and need for liver transplantation.MethodsIn a retrospective cohort, we included patients with AS‐AIH admitted to our liver center. We defined AS‐AIH based on the international autoimmune hepatitis group score as acute presentation of AIH with an international normalized ratio (INR) ≥ 1.5 and without liver cirrhosis and hepatic encephalopathy. All patients received high dose corticosteroid therapy. Treatment response was defined as liver transplant free survival at 4 months after presentation. Factors associated with response to corticosteroids and survival of patients were studied.ResultsIn total, 61 patients with AS‐AIH were included. Forty‐seven patients responded to corticosteroid therapy. In the multivariate regression model, baseline INR (odds ratio [OR]: 0.184; 95% confidence interval [CI]: 0.048–0.699; p = 0.013) and delayed versus early initiation of corticosteroid (after vs. before 5 days of presentation) (OR: 0.189; 95% CI: 0.039–0.919; p = 0.039) were independent predictors of clinical non‐response to corticosteroid therapy. In the multivariable Cox regression model, baseline INR level (OR: 2.542; 95% CI: 1.188–5.440; p = 0.016) and delayed initiation of corticosteroids (OR: 3.578; 95% CI: 1.084–11.812; p = 0.036) were independent predictors of liver transplant free survival at 6 months after diagnosis.ConclusionDelayed initiation of corticosteroid therapy might be predictive of clinical non‐response to medical therapy and need for liver transplantation in patients with AS‐AIH.

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Identifying the early predictors of non-response to steroids in patients with flare of autoimmune hepatitis causing acute-on-chronic liver failure

et al. 2023

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Early Dynamics of MELD Scores Predict Corticosteroid Responsiveness to Severe Acute-Onset Autoimmune Hepatitis

Cited by 7 publications

References 8 publications

Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation

Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation

Outcomes of patients with acute severe autoimmune hepatitis: Predictors of non‐response to corticosteroids and need for liver transplantation

Identifying the early predictors of non-response to steroids in patients with flare of autoimmune hepatitis causing acute-on-chronic liver failure

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