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Acute Severe Autoimmune Hepatitis: Corticosteroids or Liver Transplantation?
- Source :
-
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2019 Jun; Vol. 25 (6), pp. 946-959. Date of Electronic Publication: 2019 Apr 25. - Publication Year :
- 2019
-
Abstract
- 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.<br /> (Copyright © 2019 by the American Association for the Study of Liver Diseases.)
- Subjects :
- Adult
Child
Clinical Decision-Making
Glucocorticoids standards
Hepatitis, Autoimmune immunology
Hepatitis, Autoimmune therapy
Humans
Liver immunology
Liver physiopathology
Liver Failure, Acute diagnosis
Liver Failure, Acute etiology
Liver Failure, Acute immunology
Liver Function Tests
Practice Guidelines as Topic
Recurrence
Severity of Illness Index
Time-to-Treatment standards
Glucocorticoids therapeutic use
Hepatitis, Autoimmune complications
Liver Failure, Acute therapy
Liver Transplantation standards
Patient Selection
Subjects
Details
- Language :
- English
- ISSN :
- 1527-6473
- Volume :
- 25
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
- Publication Type :
- Academic Journal
- Accession number :
- 30900368
- Full Text :
- https://doi.org/10.1002/lt.25451