Background and Aims: Discrimination of acute severe autoimmune hepatitis AIH and drug induced liver injury in patients with indeterminate acute severe Hepatitis is challenging. Early corticosteroid therapy may prevent the progression to acute liver failure and the need for liver transplantation. We aimed to investigate the clinical outcomes of patients with AIH and DILI with particular focus on the role of corticosteroids.

Method:A retrospective analysis of data identified 1039 patients presenting with ASH (defined by ALT>5xULN) in two German liver centers.

Results: 67 patients were diagnosed with AIH and 52 with DILI. Only 34% of the patients with AIH displayed a positive AIH score, whereas 66% showed an indeterminate(34%) or negative(32%) score. Histology confirmed AIH in only14% of cases, whereas86% of the liver biopsies showed findings being either only compatible(46%) or atypical(40%) for AIH. Interestingly, patients with DILI had a significant higher MELD score when compared to patients with AIH(MELD21 range6-40 vs. MELD15 range6-26p<0.01). In parallel, initial ALT values in patients with DILI(mean 1846 U/L range 356-12330U/L) were significantly higher when compared to AIH patients(mean 1208U/L range 304-4095 U/L p=0.01) and decreased significantly faster upon corticosteroid treatment(p<0.01). Hence, DILI patients required a significant shorter course of steroid therapy(mean 87 days range 3-300 vs. mean 366 days range 60-1080(p<0.0001). Moreover, steroid tapering in AIH was commonly associated with an ALT flare requiring an intensified immunosuppressive regimen, which was not detected in patients with DILI(0% ALT flares, p<0.001). 1-year patient survival was 97% for AIH and 95% for DILI. In the whole cohort infection rates remained low (mild infection:7%; severe infection:6%). Seven patients(6%) with DILI required liver transplantation. Within the DILI cohort, they displayed significant higher MELD scores and Quick levels at time-point of admission (MELD:30, range23-40; Quick:29 range 12 -47, p< 0.05) as indicators for a severe stadium of disease. One-year transplant survival was 85%.

Conclusion:Early corticosteroid therapy is warranted in patients with acute severe hepatitis suspicious for AS-AIH or DILI and results in good response and survival rates avoiding liver transplantation.

CITATION INFORMATION: Mohr E., Sucher R., Müller T., Kaiser T., Berg T. Impact of Early Corticosteroid Treatment in Patients with Indeterminate Acute Severe Hepatitis Am J Transplant. 2017;17 (suppl 3).

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