Korean J Hepatol.  2010 Mar;16(1):19-28. 10.3350/kjhep.2010.16.1.19.

Clinical features of patients with fulminant hepatitis A requiring emergency liver transplantation: comparison with acute liver failure due to other causes

• Kim JD
• Choi JY
• Park CH
• Song MJ
• Jang JW
• Bae SH
• Yoon SK
• Lee YS
• You YK
• Kim DG

• KMID: 1782217
• DOI: http://doi.org/10.3350/kjhep.2010.16.1.19

Abstract

BACKGROUND/AIMS: According to recent prevalence of hepatitis A virus (HAV) infection, acute liver failure (ALF) due to HAV infection is observed frequently in parallel. The aim of this study was to elucidate the clinical, laboratory, and pathologic features of patients who have undergone emergency liver transplantation (LT) due to fulminant HAV infection.
METHODS
Clinical, laboratory, and pathologic data of 11 transplant recipients with anti-HAV IgM-positive ALF between December 2007 and May 2009 were analyzed, and compared with data of 10 recipients who underwent LT for the management of ALF due to other causes.
RESULTS
The median age of the patients with HAV-related ALF was 34 years (range: 15-43 years). The levels of hemoglobin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and creatinine were higher and the level of bilirubin was lower in the HAV-related ALF group than in the other group (P=0.005, 0.001, 0.001, 0.010, and 0.003, respectively). The time from the onset of initial symptoms to the development of encephalopathy was shorter in the HAV-related ALF group than in the other group (median 5 days, range: 4-13 days; P<0.001). In patients with HAV-related ALF, laboratory findings and clinical prognostic parameters including the Acute Liver Failure Study Group prognostic index, King's College criteria, and model for endstage liver disease (MELD) and Child-Pugh scores were not associated with the grade of hepatic encephalopathy or time of progression to encephalopathy.
CONCLUSIONS
The results of this study indicate that the clinical condition of patients with HAV-related ALF requiring emergency LT aggravates rapidly. Prognostic parameters are not sufficient for discriminating transplant candidates in patients with fulminant hepatitis A.

Keyword

Hepatitis A; Liver Failure, Fulminant; Liver Transplantation; Hepatic Encephalopathy; Prognosis

MeSH Terms

Adolescent
Adult
Aged
Alanine Transaminase/blood
Aspartate Aminotransferases/blood
Bilirubin/blood
Creatine/blood
Emergencies
Female
Hemoglobins/analysis
Hepatitis A/*complications
Hepatitis A Antibodies/immunology/metabolism
Humans
Immunoglobulin M/metabolism
Liver Failure, Acute/complications/*diagnosis/therapy
*Liver Transplantation
Male
Middle Aged
Prognosis
Severity of Illness Index
Time Factors