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World J Gastroenterol. Nov 7, 2006; 12(41): 6678-6682
Published online Nov 7, 2006. doi: 10.3748/wjg.v12.i41.6678
Arterial steroid injection therapy can inhibit the progression of severe acute hepatic failure toward fulminant liver failure
Kazuhiro Kotoh, Munechika Enjoji, Makoto Nakamuta, Tsuyoshi Yoshimoto, Motoyuki Kohjima, Shusuke Morizono, Shinsaku Yamashita, Yuki Horikawa, Kengo Yoshimitsu, Tsuyoshi Tajima, Yoshiki Asayama, Kousei Ishigami, Masakazu Hirakawa
Kazuhiro Kotoh, Munechika Enjoji, Makoto Nakamuta, Tsuyoshi Yoshimoto, Motoyuki Kohjima, Shusuke Morizono, Shinsaku Yamashita, Yuki Horikawa, Department of Medicine and Bioregulatory Science, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
Kengo Yoshimitsu, Tsuyoshi Tajima, Yoshiki Asayama, Kousei Ishigami, Masakazu Hirakawa, Department of Clinical Radiology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
Correspondence to: Kazuhiro Kotoh, Department of Medicine and Bioregulatory Science, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. kotoh-k@intmed3.med.kyushu-u.ac.jp
Telephone: +81-92-6425282 Fax: +81-92-6425287
Received: August 31, 2006
Revised: September 3, 2006
Accepted: September 6, 2006
Published online: November 7, 2006
Abstract

AIM: To utilize transcatheter arterial steroid injection therapy (TASIT) via the hepatic artery to reduce hepatic macrophage activity in patients with severe acute hepatic failure.

METHODS: Thirty-four patients with severe acute hepatic failure were admitted to our hospital between June 2002 to June 2006 providing for the possibility of liver transplantation (LT). Seventeen patients were treated using traditional liver supportive procedures, and the other 17 patients additionally underwent TASIT with 1000 mg methylprednisolone per day for 3 continuous days.

RESULTS: Of the 17 patients who received TASIT, 13 were cured without any complications, 2 died, and 2 underwent LT. Of the 17 patients who did not receive TASIT, 4 were self-limiting, 7 died, and 6 underwent LT. Univariate logistic analysis revealed that ascites, serum albumin, prothrombin time, platelet count, and TASIT were significant variables for predicating the prognosis. Multivariate logistic regression analysis using stepwise variable selection showed that prothrombin time, platelet count, and TASIT were independent predictive factors.

CONCLUSION: TASIT might effectively prevent the progression of severe acute hepatic failure to a fatal stage of fulminant liver failure.

Keywords: Methylprednisolone; Fulminant liver failure; Macrophage; Acute hepatic failure; Multiple logistic analysis