Editorial
Copyright ©2011 Baishideng Publishing Group Co.
World J Gastroenterol. Apr 28, 2011; 17(16): 2070-2075
Published online Apr 28, 2011. doi: 10.3748/wjg.v17.i16.2070
Table 1 Clinical characteristics of patients with autoimmune hepatitis with liver failure at initial presentation
Villamil et al[22]1(n = 28)Kessler et al[23](n = 10)Miyake et al[24](n = 11)Ichai et al[25](n = 16)Verma et al[7](n = 20)
Study designRetrospectiveRetrospectiveRetrospectiveRetrospectiveRetrospective
Age (yr)24140 ± 15.953 (16-75)36 ± 13.141.3 ± 14.2
Definition of LFNANAPT < 40% and HE ≥ grade 2HE within 12 wk of jaundiceAny grade HE and/or INR > 2
Symptoms duration2NA3.2 wk24 (16-52) dNA2.1 ± 2.5 mo3
FemaleNA8 (80%)11 (100%)14/16 (87.5%)15 (75%)
Ethnicity or country of originSouth American80% WhiteJapaneseFrench70% black
Definite/probable AIH (IAIHG4 criteria)NANA53(36%)/8 (64%)NA9(45%)/11(55%)
LC/LKM6 positive ANA/SMA7 positive6 (21.4)1 (10%)3 (18.7%)NA
22 (78.5%)7 (70%)NA11 (68.7%)20 (100%)
Bilirubin2 (mg/dL)398816.97 ± 9.8320.6 (5.9-31)425 (278-850)819.3 ± 10.3
AST or ALT2NA1179 ± 1127.17220 (59-1094)678 (60-2867)1147.1 ± 711.4
INR2 or PT30%49.3 ± 66.929% (6%-38%)5.36 (1.7-12.2)2.7 ± 1.4
HE9 at onset28 (100%)8 (80%)11 (100%)10 (62.5%)19 (95%)
CirrhosisNone2/10 (20%)NANone8/20 (40%)
MELD2NANANA37 (24-47)28 ± 7.41
Sub-massive or massive necrosis (SMN, MN)19/23 (82.6%)5/10 (50%)NA16/16 (100%) 15 needed LT and/or died12/19 (63.1%), 10 needed LT and or died
17 needed LT and/or died
Immunosuppressant regimen usedPrednisone 60 mg/dCorticosteroids (Dose NA) and other10PrednisolonePrednisone 1 mg/kg per day and other10Corticosteroids11
40-60 mg/d and steroid pulse20-1250 mg/d
Poor prognostic criteria1: PT < 20%; 2: Grade 4 HE; 3: SMN at diagnosis; 4: 20% increase in PT at day 3 of steroidsNA1: High bilirubin at onset; 2: Worsening bilirubin during days 8-15 of steroid therapyNA1: Absence of cirrhosis; 2: MELD > 28; 3: Worsening trend in bilirubin and INR after 3.7 ± 0.6 d of steroid therapy
Septic eventsNANANA7 (43.7%), of whom 6 had received steroids2 (10%), of whom 1 received steroids
Table 2 Outcomes of patients with autoimmune hepatitis and initial presentation with liver failure
StudyVillamil et al[22](n = 28)Kessler et al[23](n = 10)Miyake et al[24](n = 11)Ichai et al[25](n = 16)Verma et al[7](n = 20)
Treated with IS1251081214
Responders to steroids9 (36%) (alive)4 (40%) (alive)2 (25%) (alive)1 (8.3%) (alive)7 (50%) (alive)
Non responders1666117
LT11 (2 Died)3110 (1 Died)1 (Died)
Listed for LT-1--1 (Died)
Died without LT5251452
Not treated with IS13-3346
Spontaneous survival--3--
LT1--35 (1 Died)
Listed for LT-----
Died2--11
Overall underwent LT or listed for LT12/28 (42.8%)4/10 (40%)1/11 (9%)13/16 (81.2%)7/20 (35%)
Overall mortality9/28 (32.1%)2/10 (20%)5/11 (45.4%)3/16 (18.7%)9/20 (45%)