The interaction of CD40 with CD154 is a pivotal trigger of immune cascade-inducing acute liver failure, however its clinical significance has not been well studied. The present study aimed to investigate the clinical implications of serum-soluble CD154 (sCD154) levels and the expression of CD40 on monocytes in patients with fulminant hepatic failure (FHF). The results showed that serum sCD154 levels and CD40 expression on monocytes were significantly higher in FHF patients than in acute hepatitis (AH) patients and healthy controls, and were also significantly higher in FHF patients who died, compared with those who survived. We conclude that high serum levels of sCD154 may be linked to fatal outcome in patients with severe liver injury and may be a valuable prognostic marker for survival in patients with FHF.

https://journals.sagepub.com/doi/pdf/10.1177/147323000803600415

Predictive value of serum-soluble CD154 in fulminant hepatic failure.

Acute liver failure is a challenging clinical condition, associated with high morbidity and mortality. In well-selected patients, LT (LT) is the only therapeutic which has been demonstrated to improve patient survival. Clichy and King's College criteria are the two mains scoring systems used to select the patients for liver transplantation. Both models achieve high specificity but remain associated with limited negative predictive value. Several other predictive factors have been evaluated, but none of them have been strongly validated so far. Globally, whole LT appears as the procedure of choice for patients within Clichy and/or King's College criteria. Due to the severity of the disease and its multisystemic consequences, the results of LT for fulminant liver failure remain inferior to those obtained in elective indications. Accord-ing to local conditions, namely expected waiting time before urgent transplantation and surgical expertise, living donor transplantation and auxiliary transplantations appear as valuable alternatives. These techniques have the respective potential advantages to limit the waiting period before transplantation and to avoid the need for lifelong immunosuppression when native liver recovers, but overall results remain inferior to those obtained with whole LT.

Liver transplantation for acute liver failure in adults.

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Liver transplantation for acute liver failure in adults.