Portal de Periódicos da CAPES

Late onset hepatic failure: Clinical, serological and histological features

1986; Lippincott Williams & Wilkins; Volume: 6; Issue: 2 Linguagem: Inglês

10.1002/hep.1840060222

1527-3350

Alexander Gimson, John O’Grady, Roland Ede, Bernard Portmann, Roger Williams,

Liver Disease and Transplantation

HepatologyVolume 6, Issue 2 p. 288-294 Original ArticleFree Access Late onset hepatic failure: Clinical, serological and histological features Alexander E. S. Gimson, Alexander E. S. Gimson Liver Unit, King's College of Medicine and Dentistry, Denmark Hill, London SE5 8RX, EnglandSearch for more papers by this authorJohn O'Grady, John O'Grady Liver Unit, King's College of Medicine and Dentistry, Denmark Hill, London SE5 8RX, EnglandSearch for more papers by this authorRoland J. Ede, Roland J. Ede Liver Unit, King's College of Medicine and Dentistry, Denmark Hill, London SE5 8RX, EnglandSearch for more papers by this authorBernard Portmann, Bernard Portmann Liver Unit, King's College of Medicine and Dentistry, Denmark Hill, London SE5 8RX, EnglandSearch for more papers by this authorRoger Williams M.D., Corresponding Author Roger Williams M.D. Liver Unit, King's College of Medicine and Dentistry, Denmark Hill, London SE5 8RX, EnglandThe Liver Unit, King's College School of Medicine and Dentistry, Denmark Hill, London SE5 8RX, England===Search for more papers by this author Alexander E. S. Gimson, Alexander E. S. Gimson Liver Unit, King's College of Medicine and Dentistry, Denmark Hill, London SE5 8RX, EnglandSearch for more papers by this authorJohn O'Grady, John O'Grady Liver Unit, King's College of Medicine and Dentistry, Denmark Hill, London SE5 8RX, EnglandSearch for more papers by this authorRoland J. Ede, Roland J. Ede Liver Unit, King's College of Medicine and Dentistry, Denmark Hill, London SE5 8RX, EnglandSearch for more papers by this authorBernard Portmann, Bernard Portmann Liver Unit, King's College of Medicine and Dentistry, Denmark Hill, London SE5 8RX, EnglandSearch for more papers by this authorRoger Williams M.D., Corresponding Author Roger Williams M.D. Liver Unit, King's College of Medicine and Dentistry, Denmark Hill, London SE5 8RX, EnglandThe Liver Unit, King's College School of Medicine and Dentistry, Denmark Hill, London SE5 8RX, England===Search for more papers by this author First published: March/April 1986 https://doi.org/10.1002/hep.1840060222Citations: 153AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract The clinical, laboratory and histological features of 47 patients with what is defined as late onset hepatic failure are reviewed. Twenty-five of the patients werefemale and 22 male with a median age of 45 years. Hepatic dysfunction was severe as evidenced by the prolongation of prothrombin time (median = 32 sec, range = 17 to 120 sec). In only four cases was a viral etiology proven (2 hepatitis B, 2 hepatitis A) although the similarity of the clinical features to patients with fulminant viral hepatitis—apart from the longer period of illness prior to the onset of encephalopathy (median = 9 weeks, range = 8 to 24 weeks)—made non-A, non-B infection a possibility in the remainder. There were also similarities to chronic active hepatitis with low titer antibodies to smooth muscle or antinuclear factor in 17% and elevation of the serum IgG in 49%. Liver biopsy in 5 of 8survivors more than 1 year after initial presentation showed chronic active hepatitis in three. Lobular inflammatory infiltrate, bridging necrosis and multilobular collapse were the features of the acute stage of illness in both the survivors and fatal cases. The patients given corticosteroids did not have a statistically significant improvement in survival, and overall mortality for the series was 81%. Hepatic transplantation, successfully performed in one patient, would appear to offer the best chance of survival for the majority of these patients. References 1 Trey C, Davidson C. The management of fulminant hepatic failure. In: H Popper, F Schaffner, eds. Progress in liver disease, Vol 3. New York: Grune & Stratton, 1970: 292– 298. 2 Gimson A, White Y, Eddleston ALWF, et al. Clinical and prognostic differences in fulminant hepatitis type A, B and non-A, non-B. Gut 1983; 24: 1194– 1198. 3 Mathiesen L, Skinoj P, Nielsen N, et al. Hepatitis type A, B and non-A, non-B in fulminant heptitis. Gut 1980; 21: 72– 77. 4 Conn HO. Chronic hepatitis: reducing an iatrogenic enigma to a workable puzzle. Gastroenterology 1976; 70: 1182– 1184. 5 Bjorneboe M, Raashou F. The pathology of subchronic atrophy of the liver. A comparison with cirrhosis, hepatitis Laennec. Acta Med Scand (Suppl) 1949; 234: 41– 62. 6 Tisdale W. Medical progress. Subacute hepatitis. N Engl J Med 1970; 266: 85– 89. 7 Redeker A. Advances in clinical aspects of acute and chronic liver disease of viral origin. In: G Vijas. S Cohen, R Schmid, eds. Viral hepatitis: a contemporary assessment of etiology, epidemiology, pathogenesis and prevention. Philadelphia: The Franklin Institute Press, 1978: 425– 429. 8 Boyer J, Klatskin G. Pattern of necrosis in acute viral hepatitis. Prognostic value of bridging subacute hepatic necrosis. N Engl J Med 1970; 283: 1063– 1071. 9 Peters R, Omata M, Aschavai M, et al. Protracted viral hepatitis with impaired regeneration. In: G Vyas, S Cohen, R Schmid, eds. Viral hepatitis: a contemporary assessment of etiology, epidemiology, pathogenesis and prevention. Philadelphia: The Franklin Institute Press, 1978: 79– 84. 10 Horney J, Galambos JT. The liver during and after fulminant hepatitis. Gastroenterology 1977; 73: 639– 645. 11 Spitz R, Karen D, Boitnott V, et al. Bridging hepatic necrosis. Etiology and prognosis. Dig Dis 1978; 23: 1076– 1078 12 Baggenstoss A, Soloway R, Summerskill W, et al. Chronic active liver disease. The range of histologic lesions, their response to treatment and evolution. Hum Pathol 1972; 3: 183– 198. 13 Ware A, Cuthbert J, Shorey J, et al. A prospective trial of steroid therapy in severe viral hepatitis. The prognostic significance of bridging necrosis. Gastroenterology 1981; 80: 219– 224. 14 E.A.S.L. Study Group. Randomised trial of steroid therapy in acute liver failure. Gut 1979; 20: 620– 623. 15 Canalese J, Gimson AES, Davis C, et al. A controlled trial of dexamethasone and mannitol for the cerebral oedema of fulminant hepatic failure. Gut 1982; 23: 625– 629. 16 Tedder R, Wilson-Croom R. Detection by RIA of IgM class antibody to HB core antigen: comparison of two methods. J Med Virol 1980; 6: 235– 247. 17 Benhamou J, Rueff B. Acute hepatic necrosis. Gut 1973; 14: 805– 815. 18 Dietrichson O, Juhl E, Christoffersen P, et al. Acute viral hepatitis: factors possibly predicting chronic liver disease. Acta Path Microbiol Scand (Sect. A) 1975; 83: 183– 188. 19 Williams R, Gimson AES. An assessment of orthotopic liver transplantation in acute liver failure. Hepatology 1984; 4: 22– 45. 20 Williams R, Caine R, Rolles K, et al. Current results with orthotopic liver grafting in Cambridge/King's College Hospital series. Br Med J 1985; 290: 49– 52. Citing Literature Volume6, Issue2March/April 1986Pages 288-294 ReferencesRelatedInformation