3 research outputs found
Multicentre international evaluation of autoimmune hepatitis and liver transplantation: disease recurrence is associated with recipient features, type of immunosuppression and impaired outcomes
Risk factors and outcomes associated with recurrent autoimmune hepatitis following liver transplantation
BACKGROUND & AIMS: The impact of recurrent autoimmune hepatitis (AIH) post-liver transplant on patient and graft survival is not well characterised. We evaluated a large, international multi-center cohort to identify the probability and risk factors associated with recurrent AIH and the association between recurrent disease and patient and graft survival.
METHODS: We included 736 patients (77% female, mean age, 42±1 years) with AIH who underwent LT from January 1987 through June 2020, among 33 centers in North America, South America, Europe and Asia. Clinical data before and after LT, biochemical data within the first 12 months after LT, and immunosuppression after LT were analyzed to identify patients with higher risk of recurrence of AIH based on histological diagnosis.
RESULTS: AIH recurred in 20% of patients after 5 years and 31% after 10 years. Age at LT ≤42 years (HR, 3.15; 95% CI, 1.22-8.16; p=0.02), use of mycophenolate mofetil post-LT (HR, 3.06; 95% CI, 1.39-6.73; p=0.005), donor and recipient sex mismatch (HR, 2.57; 95% CI, 1.39-4.76; p=0.003) and high IgG pre-LT (HR, 1.04; 95% CI, 1.01-1.06; p=0.004) were associated with higher risk of AIH recurrence after adjusting for other confounders. In multivariate Cox regression with time-dependent covariate, recurrent AIH significantly associated with graft loss (HR, 10.79, 95% CI 5.37-21.66, p\u3c0.001) and death (HR, 2.53, 95% CI 1.48-4.33, p=0.001).
CONCLUSION: Recurrence of AIH following transplant is frequent and is associated with younger age at LT, use of mycophenolate mofetil post-LT, sex mismatch and high IgG pre-LT. We demonstrate an association between disease recurrence and impaired graft and overall survival in patients with AIH, highlighting ongoing efforts to better characterize, prevent and treat recurrent AIH.
LAY ABSTRACT: Recurrent autoimmune hepatitis following liver transplant is frequent and is associated with some recipient features and the type of antirejection medications. Recurrent autoimmune hepatitis negatively affects the outcome after liver transplant
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Risk factors and outcomes associated with recurrent autoimmune hepatitis following liver transplantation.
Autoimmune hepatitis can recur after liver transplantation (LT), though the impact of recurrence on patient and graft survival has not been well characterized. We evaluated a large, international, multicenter cohort to identify the probability and risk factors associated with recurrent AIH and the association between recurrent disease and patient and graft survival. We included 736 patients (77% female, mean age 42±1 years) with AIH who underwent LT from January 1987 through June 2020, among 33 centers in North America, South America, Europe and Asia. Clinical data before and after LT, biochemical data within the first 12 months after LT, and immunosuppression after LT were analyzed to identify patients at higher risk of AIH recurrence based on histological diagnosis. AIH recurred in 20% of patients after 5 years and 31% after 10 years. Age at LT ≤42 years (hazard ratio [HR] 3.15; 95% CI 1.22-8.16; p = 0.02), use of mycophenolate mofetil post-LT (HR 3.06; 95% CI 1.39-6.73; p = 0.005), donor and recipient sex mismatch (HR 2.57; 95% CI 1.39-4.76; p = 0.003) and high IgG pre-LT (HR 1.04; 95% CI 1.01-1.06; p = 0.004) were associated with higher risk of AIH recurrence after adjusting for other confounders. In multivariate Cox regression, recurrent AIH (as a time-dependent covariate) was significantly associated with graft loss (HR 10.79, 95% CI 5.37-21.66, p Recurrence of AIH following transplant is frequent and is associated with younger age at LT, use of mycophenolate mofetil post-LT, sex mismatch and high IgG pre-LT. We demonstrate an association between disease recurrence and impaired graft and overall survival in patients with AIH, highlighting the importance of ongoing efforts to better characterize, prevent and treat recurrent AIH. Recurrent autoimmune hepatitis following liver transplant is frequent and is associated with some recipient features and the type of immunosuppressive medications use. Recurrent autoimmune hepatitis negatively affects outcomes after liver transplantation. Thus, improved measures are required to prevent and treat this condition