Editorial
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World J Hepatol. Nov 27, 2010; 2(11): 395-400
Published online Nov 27, 2010. doi: 10.4254/wjh.v2.i11.395
A new treatment strategy for acute liver failure
Kazuhiro Kotoh, Masaki Kato, Motoyuki Kohjima, Makoto Nakamuta, Munechika Enjoji
Kazuhiro Kotoh, Masaki Kato, Department of Hepatology and Pancreatology, Kyushu University Hospital, Fukuoka 812-8582, Japan
Motoyuki Kohjima, Makoto Nakamuta, Department of Gastroenterology and Clinical Research Center, Kyushu Medical Center, National Hospital Organization, Fukuoka 810-8563, Japan
Munechika Enjoji, Health Care Center, Fukuoka University, Fukuoka 814-0180, Japan
Author contributions: Kotoh K and Enjoji M drafted the editorial; and all of the authors wrote the final version.
Correspondence to: Kazuhiro Kotoh, MD, Department of Gastroenterology and Clinical Research Center, Kyushu Medical Center, National Hospital Organization, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan. kotoh-k@intmed3.med.kyushu-u.ac.jp
Telephone: +81-92-6425282 Fax: +81-92-6425287
Received: July 17, 2010
Revised: October 18, 2010
Accepted: October 25, 2010
Published online: November 27, 2010
Abstract

Acute liver failure (ALF) is a syndrome defined by coagulopathy and encephalopathy and no effective treatments have been established, except for liver transplantation. However, considering the limited supply of donors, we should endeavor to prevent the progression of this syndrome in its early stage to improve the prognosis of patients with ALF. Recently, several authors have reported that over-activation of intrahepatic macrophages plays an important role in the progression of ALF and we have developed a new treatment method, transcatheter arterial steroid injection therapy (TASIT), to suppress macrophage activation. We have now used TASIT for 5 years and have found that TASIT is effective for patients with over-activation of macrophages in the liver but not for those with lesser activation of macrophages. Therefore, to identify the most appropriate patients for TASIT, we tried to categorize patients with ALF or acute liver injury according to markers for the degree of intrahepatic macrophage activation. This approach was helpful to select the appropriate treatment including liver transplantation. We believe that it is essential to analyze disease progression in each patient before selecting the most appropriate treatment.

Keywords: Acute liver failure; Steroids; Macrophages; Hepatitis; Ferritin