Early liver transplantation for corticosteroid non-responders in acute severe autoimmune hepatitis: the SURFASA score.
In acute severe autoimmune hepatitis (AS-AIH), the optimal timing for liver transplantation (LT) remains controversial. The objectives of this study were to determine early predictive factors for a non-response to corticosteroids and to propose a score to identify patients in whom LT is urgently indicated.This was a retrospective, multicenter study (2009-2016). A diagnosis of AS-AIH was based on: 1. Definite or probable simplified IAIHG score; 2. INR ≥1.5 and/or bilirubin >200 μmol/L; 3. No previous history of AIH; 4. Histologically-proven AIH. A treatment response was defined as LT-free survival at 90 days. The evolution of variables from corticosteroid initiation (day-D0) to D3 was estimated from: Δ%3=(D3 – D0)/D0.128 patients were included, median age of 52 [39-62] years; 72% were female. Overall survival reached 88%. 115 patients (90%) received corticosteroids with a 66% LT-free survival rate at 90 days. Under multivariate analysis, D0-INR (odds ratio [OR] 6.85; 95%CI 2.23-21.06, p<0.001), Δ%3-INR≥0.1% (OR 6.97; 95%CI 1.59-30.46, p<0.01) and Δ%3-bilirubin≥-8% (OR 5.14; 95%CI 1.09-24.28, p<0.04) were predictive of a non-response. The SURFASA score -6.80+1.92*(D0-INR) +1.94*(Δ%3-INR)+ 1.64*(Δ%3-bilirubin), created by combining these variables, was highly predictive of LT or death (AUC=0.93) (88% specificity; 84% sensitivity) with a cut-off point of