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Acute Severe Autoimmune Hepatitis: Corticosteroids or Liver Transplantation?
Author(s) -
Rahim Mussarat N.,
Liberal Rodrigo,
Miquel Rosa,
Heaton Nigel D.,
Heneghan Michael A.
Publication year - 2019
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.25451
Subject(s) - medicine , autoimmune hepatitis , liver transplantation , hepatic encephalopathy , liver disease , disease , encephalopathy , transplantation , intensive care medicine , population , coagulopathy , model for end stage liver disease , hepatitis , pediatrics , immunology , cirrhosis , environmental health
Acute severe presentations of autoimmune hepatitis (AIH) represent a challenge for the transplant community. As a disease, it is poorly characterized, and there is a weak evidence base to guide diagnosis and treatment. Early identification of acute severe AIH is key because it determines the initiation of corticosteroids, which can be lifesaving. However, their use in this setting remains controversial. The Model for End‐Stage Liver Disease score, severity of coagulopathy, and grade of encephalopathy may be predictors of outcome with corticosteroid therapy. The optimal timing of liver transplantation (LT) can be difficult to determine and, as such, the decision to proceed to transplantation should not be delayed by protracted courses of corticosteroids. The aim of this review is to better characterize this subset of patients; to differentiate them clinically, serologically, and histologically from chronic AIH and other causes of acute liver failure; and to present the role, predictors, and optimal timings of corticosteroid therapy and LT. Although this review is specific to adults, many principles hold true for the pediatric population.