| [ Summary ] |
Fulminant hepatitis (FH) is defined as severe hepatitis caused by rapid and extensive hepatocyte destruction in patients without a previous history of liver disease. However, in relation to FH caused by the hepatitis B virus (HBV), the term FH causes difficalties, because of fulminant hepatic failure (FHF) occurring during chronic HBV infection. In Japan, there are two kinds of FHF, including FH, related to HBV. One is FH-B, caused by acute infection with HBV and the other is FHF-B, occurring during chronic HBV infection. The difference between the two types of infection is their pathogenesis and prognosis. The prognosis for FH-B, due to acute infection, is generally favorable when patients are kept alive through intensive liver support such as the one we originated. This is true except for the "hyperacute type", in which the whole liver is almost instantaneously destroyed at the onset of the disease, and accordingly considered to be the "hyper acute type". That type of patient is an absolutely indicated for liver transplantation. The prognosis for FHF-B accompanied by chronic infection is generally less favorable, unless both persistent HBV replication and enhanced host immune reactions are effectively suppressed by the combination of antiviral and immunosuppressive treatments. If the start of treatment is delayed, patients must receive liver transplants which is very difficult for these patients. |