Display options
Cite
Fujiwara K, Yasui S, Yokosuka O. Autoimmune acute liver failure: an emerging etiology for intractable acute liver failure. Hepatol Int. 2012;7(2):335-46doi: 10.1007/s12072-012-9402-3.
Fujiwara, K., Yasui, S., & Yokosuka, O. (2013). Autoimmune acute liver failure: an emerging etiology for intractable acute liver failure. Hepatology international, 7(2), 335-46. https://doi.org/10.1007/s12072-012-9402-3
Fujiwara, Keiichi, et al. "Autoimmune acute liver failure: an emerging etiology for intractable acute liver failure." Hepatology international vol. 7,2 (2013): 335-46. doi: https://doi.org/10.1007/s12072-012-9402-3
Fujiwara K, Yasui S, Yokosuka O. Autoimmune acute liver failure: an emerging etiology for intractable acute liver failure. Hepatol Int. 2013 Jun;7(2):335-46. doi: 10.1007/s12072-012-9402-3. Epub 2012 Sep 28. PMID: 26201768.
Copy Download .nbib Format: NLM
Share it on

Hepatol Int. 2013 Jun;7(2):335-46. doi: 10.1007/s12072-012-9402-3. Epub 2012 Sep 28.

Autoimmune acute liver failure: an emerging etiology for intractable acute liver failure.

Hepatology international

Keiichi Fujiwara, Shin Yasui, Osamu Yokosuka

Affiliations

  1. Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. [email protected].
  2. Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.

PMID: 26201768 DOI: 10.1007/s12072-012-9402-3

Abstract

Diagnosis of acute onset autoimmune hepatitis (AIH) is the most challenging task because of atypical clinicopathological features. We examined the nature of acute onset AIH consisting of nonsevere, severe, and fulminant AIH based on our published data and other published papers, and propose how to diagnose and treat this intractable hepatitis. We analyzed clinical, biochemical, immunological, radiological, and histological features of acute onset AIH. Thirty percent of fulminant hepatitis was due to AIH and autoimmune acute liver failure (ALF) was not rare. The important characteristic of acute onset AIH is its histological, radiological, and clinical heterogeneity. Sometimes acute onset AIH develops into ALF in a sub-acute clinical course without appropriate diagnosis and treatment, and becomes resistant to immunosuppressive therapy and has poor prognosis. Unenhanced computed tomography (CT) often shows heterogeneous hypoattenuation in autoimmune ALF. The revised original scoring system (1999) performed better in patients with acute onset AIH than the simplified scoring system (2008). Liver regeneration from periportal progenitor cells to mature hepatocytes was impaired in ALF, resulting in resistance to immunosuppressive therapy. Precise histological evaluation (the presence of centrilobular necrosis/collapse) along with the revised original scoring system and CT findings of heterogeneous hypoattenuation after systematic exclusion of other causes 36 plays an important role in the diagnosis. The most important strategy for autoimmune ALF is to diagnose and treat acute onset AIH before its development into ALF. Liver transplantation should be considered before the occurrence of infectious complications in the case of fulminant liver failure.

Keywords: Acute liver failure; Autoimmune hepatitis; CT; Cytokeratin 7; Fulminant hepatitis; Heterogeneity; Liver regeneration; Severe hepatitis

References

  1. J Gastroenterol. 2008;43(9):711-9 - PubMed
  2. J Hepatol. 2004 Dec;41(6):983-91 - PubMed
  3. World J Gastroenterol. 2010 Feb 28;16(8):934-47 - PubMed
  4. Liver. 1984 Dec;4(6):379-86 - PubMed
  5. Liver Transpl. 2007 Jul;13(7):953-5 - PubMed
  6. J Clin Pathol. 2006 Mar;59(3):246-9 - PubMed
  7. Radiology. 1996 Jan;198(1):239-42 - PubMed
  8. J Hepatol. 1999 Nov;31(5):929-38 - PubMed
  9. Clin Gastroenterol Hepatol. 2004 Jul;2(7):625-31 - PubMed
  10. Hepatol Res. 2011 Jun;41(6):497 - PubMed
  11. Hepatology. 2010 Jun;51(6):2193-213 - PubMed
  12. J Gastroenterol. 2011 Sep;46(9):1136-41 - PubMed
  13. Gastroenterology. 1993 Dec;105(6):1824-32 - PubMed
  14. Am J Gastroenterol. 2002 Oct;97(10):2670-3 - PubMed
  15. Histopathology. 2011 Apr;58(5):693-704 - PubMed
  16. Intern Med. 2007;46(1):1-2 - PubMed
  17. Hepatol Res. 2008 Jul;38(7):646-57 - PubMed
  18. Hepatology. 2011 Feb;53(2):517-26 - PubMed
  19. Dig Dis Sci. 2011 Dec;56(12):3638-47 - PubMed
  20. Dig Liver Dis. 2011 Aug;43(8):666-7 - PubMed
  21. J Pediatr Gastroenterol Nutr. 1990 Jul;11(1):138-40 - PubMed
  22. Hepatology. 1993 Oct;18(4):998-1005 - PubMed
  23. Hepatol Res. 2003 Mar;25(3):263-270 - PubMed
  24. Liver Transpl. 2008 Oct;14 Suppl 2:S67-79 - PubMed
  25. Gastroenterology. 1997 Aug;113(2):664-8 - PubMed
  26. Hepatol Res. 2012 Jan;42(1):42-50 - PubMed
  27. Gastroenterology. 1983 Sep;85(3):713-7 - PubMed
  28. Gut. 1997 Aug;41(2):269-71 - PubMed
  29. Hepatology. 2009 Aug;50(2):538-45 - PubMed
  30. World J Gastroenterol. 2005 Feb 28;11(8):1109-14 - PubMed
  31. Hepatology. 2008 Nov;48(5):1540-8 - PubMed
  32. Am J Surg Pathol. 1995 Jun;19(6):699-708 - PubMed
  33. J Gastroenterol. 2011 Mar;46(3):378-90 - PubMed
  34. Hepatol Res. 2008 Aug;38(8):784-9 - PubMed
  35. Dig Dis Sci. 1995 Feb;40(2):435-56 - PubMed
  36. Hepatology. 2008 Apr;47(4):1401-15 - PubMed
  37. Ann Intern Med. 2002 Dec 17;137(12):947-54 - PubMed
  38. Aliment Pharmacol Ther. 2006 May 1;23(9):1347-53 - PubMed
  39. Liver Transpl. 2007 Jul;13(7):996-1003 - PubMed
  40. J Gastroenterol. 2010 Dec;45(12):1255-62 - PubMed
  41. Hepatology. 2001 Mar;33(3):738-50 - PubMed
  42. Am J Surg Pathol. 2004 Apr;28(4):471-8 - PubMed
  43. Clin Gastroenterol Hepatol. 2007 Feb;5(2):255-8 - PubMed
  44. Hepatology. 2008 Jul;48(1):169-76 - PubMed
  45. Hepatol Res. 2011 Feb;41(2):133-41 - PubMed
  46. Hum Pathol. 2007 Nov;38(11):1669-75 - PubMed
  47. J Hepatol. 1994 Nov;21(5):866-71 - PubMed
  48. Hepatology. 1994 Jul;20(1 Pt 2):S5-10S - PubMed
  49. Hepatology. 2011 Jul;54(1):371-2; author reply 373 - PubMed
  50. Liver Int. 2011 Aug;31(7):1013-20 - PubMed
  51. J Gastroenterol. 2008;43(12):951-8 - PubMed
  52. Hepatol Res. 2001 Nov;21(3):213-219 - PubMed

Publication Types