Special Report Distribution of core hospitals for patients with fulminant hepatitis and late onset hepatic failure in Japan Keiichi Fujiwara, 1 Osamu Yokosuka, 1 Kazuaki Inoue, 2 Shin Yasui, 1 Ryuzo Abe, 3 Shigeto Oda, 3 Shinju Arata, 4 Yasuhiro Takikawa, 5 Akio Ido, 6 Satoshi Mochida, 7 Hirohito Tsubouchi, 8 Hajime Takikawa 9 and The Intractable Hepato-Biliary Disease Study Group of Japan 10 Departments of 1 Gastroenterology and Nephrology and 3 Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, and 2 Division of Gastroenterology, Showa University Fujigaoka Hospital, 4 Yokohama City University School of Medicine, Yokohama, 5 Department of Gastroenterology and Hepatology, Iwate Medical University, Morioka, 6 Department of Digestive and Lifestyle Related Disease, Health Research Course, Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, 8 Kagoshima City Hospital, Kagoshima, 7 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Saitama Medical University, Moroyama, 9 Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan, and 10 The Ministry of Health Labor and Welfare of Japan Key words: acute liver failure, fulminant hepatitis, late onset hepatic failure INTRODUCTION A CUTE LIVER FAILURE (ALF) including fulminant hepatitis (FH) and late onset hepatic failure (LOHF) is a worldwide problem despite its rare incidence because of its extremely high mortality. There are no beneficial therapies except emergency liver transplantation (LT) for ALF. In Japan, only 20% of eligible patients undergo LT because of a shortage of donor livers, 1,2 therefore, treatment strategies other than LT must be further investigated for patients with ALF. For developing the strategies, it is important to know the actual situation, in which hospital are patients with ALF treated, how many patients are treated in each hospital and which hospitals are core centers. We examined the number of total cases of FH or LOHF between 2004 and 2011 in combination with the methods of artificial liver supports (ALS) by sending the question- naires to 987 nationwide hospitals. We have published manuscripts about the present status of ALS methods in Ja- pan 3 and the desirable methods which should be stan- dardized. 4 On counting the number of cases, we could not exclude overlapping cases due to patients’ privacy protection. For example, some cases may exist who were treated at a department of internal medicine in a primary hospital and transferred to a transplant center. An accurate number of cases without overlap can be provided by the annual report of the Intractable Hepato-Biliary Disease Study Group of Japan supported by the Ministry of Health, Labor and Welfare in Japan. We could receive responses from 210 hospitals. One thousand and fifty-six patients with FH or LOHF were treated in 113 hospitals, comprising 512 patients with FH acute type, 482 with FH subacute type and 62 with LOHF during the 8years. No case was found in 97 hospi- tals, one to seven cases (an average of less than one case each year) in 67, eight to 15 cases (one to two cases each year) in 27, 16 to 23 cases (two to three cases each year) in 10, 24 to 31 cases (three to four cases each year) in five, 32 to 39 cases (four to five cases each year) in none, and equal to or more than 40 cases (equal to or more than five cases each year) in four. The number of cases per hospital varied from zero to 67 (median, one). Hospitals with equal to or more than eight cases occupied 79% of all cases, those with equal to or more than 16 cases 50%, those with equal to or more than 24 cases 32%, and those with equal to or more than 40 cases 20%. Thus, it was con- firmed clearly that patients with FH and LOHF accumu- lated in limited hospitals (Table 1). Hospitals with more than 16 cases (an average of more than two cases each year) are shown in Figures 1 and 2. Correspondence: Keiichi Fujiwara, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. Email: fujiwara-cib@umin.ac.jp Received 15 April 2015; revision 1 June 2015; accepted 5 June 2015. 10 © 2015 The Japan Society of Hepatology Hepatology Research 2016; 46: 10–12 doi: 10.1111/hepr.12543