Risk factors and outcomes associated with recurrent autoimmune hepatitis following liver transplantation.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Montano-Loza Aldo J, Ronca Vincenzo, Ebadi Maryam, Hansen Bettina E, Hirschfield Gideon, Elwir Saleh, Alsaed Mohamad, Milkiewicz Piotr, Janik Maciej K, Marschall Hanns-Ulrich, Burza Maria Antonella, Efe Cumali, Calışkan Ali Rıza, Harputluoglu Murat, Kabaçam Gökhan, Terrabuio Débora, de Quadros Onofrio Fernanda, Selzner Nazia, Bonder Alan, Parés Albert, Llovet Laura, Akyıldız Murat, Arikan Cigdem, Manns Michael P, Taubert Richard, Weber Anna-Lena, Schiano Thomas D, Haydel Brandy, Czubkowski Piotr, Socha Piotr, Ołdak Natalia, Akamatsu Nobuhisa, Tanaka Atsushi, Levy Cynthia, Martin Eric F, Goel Aparna, Sedki Mai, Jankowska Irena, Ikegami Toru, Rodriguez Maria, Sterneck Martina, Weiler-Normann Christina, Schramm Christoph, Donato Maria Francesca, Lohse Ansgar, Andrade Raul J, Patwardhan Vilas R, van Hoek Bart, Biewenga Maaike, Kremer Andreas E, Ueda Yoshihide, Deneau Mark, Pedersen Mark, Mayo Marlyn J, Floreani Annarosa, Burra Patrizia, Secchi Maria Francesca, Beretta-Piccoli Benedetta Terziroli, Sciveres Marco, Maggiore Giuseppe, Jafri Syed-Mohammed, Debray Dominique, Girard Muriel, Lacaille Florence, Lytvyak Ellina, Mason Andrew L, Heneghan Michael, Oo Ye Htun, International Autoimmune Hepatitis Group (IAIHG)
Аннотация
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 at higher risk of AIH recurrence based on histological diagnosis.
RESULTS: 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 <0.001) 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 the importance of ongoing efforts to better characterize, prevent and treat recurrent AIH.
LAY SUMMARY: 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.