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Infectious complications, steroid use and timing for emergency liver transplantation in acute liver failure: analysis in a Japanese center
Author(s) -
Yasui Shin,
Fujiwara Keiichi,
Haga Yuuki,
Nakamura Masato,
Mikata Rintaro,
Arai Makoto,
Kanda Tatsuo,
Oda Shigeto,
Yokosuka Osamu
Publication year - 2016
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.399
Subject(s) - medicine , liver transplantation , incidence (geometry) , corticosteroid , economic shortage , transplantation , gastroenterology , multivariate analysis , linguistics , philosophy , physics , government (linguistics) , optics
Background Corticosteroid (CS) has been introduced in most acute liver failure (ALF) patients for the purpose of suppressing pro‐inflammatory cytokines in Japan where a shortage of donor livers exists, whereas CS use is evaluated to be no benefit in Western countries. In the present study, we aimed to clarify the association between infectious complications and CS use in ALF, and determine when to evaluate treatment response and consider the timing for switching to liver transplantation (LT). Methods Corticosteroid was administered to patients in the early stage prospectively. Clinical and biochemical features of 110 adult patients were analyzed. Results Corticosteroids were administered to 78 (71%) patients. The duration between start of CS and onset of infection was 17 ± 10 days. Multivariate analysis revealed that infection was associated with age >50 years ( P = 0.034) and T‐BIL >15 mg/dl ( P < 0.001), and not with CS use ( P = 0.10). Accumulative incidence of infection was not different between patients with and without CS ( P = 0.18). Conclusions Corticosteroid use did not significantly increase the incidence of infection. Two weeks after introduction of CS is a critical point for evaluating treatment response, avoiding infectious complications and switching to LT.