Mortality on the UNOS Waitlist for Patients with Autoimmune Liver Disease.
autoimmune hepatitis
autoimmune liver disease
liver transplant
mortality
primary biliary cholangitis
primary sclerosing cholangitis
waitlist
Journal
Journal of clinical medicine
ISSN: 2077-0383
Titre abrégé: J Clin Med
Pays: Switzerland
ID NLM: 101606588
Informations de publication
Date de publication:
23 Jan 2020
23 Jan 2020
Historique:
received:
24
12
2019
revised:
14
01
2020
accepted:
20
01
2020
entrez:
26
1
2020
pubmed:
26
1
2020
medline:
26
1
2020
Statut:
epublish
Résumé
Outcomes on the liver transplant waitlist can vary by etiology. Our aim is to investigate differences in waitlist mortality of autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) using the United Network for Organ Sharing (UNOS) database. We identified patients who were listed for liver transplantation from 1987 to 2016 with a primary diagnosis of AIH, PBC, or PSC. We excluded patients with overlap syndromes, acute hepatic necrosis, missing data, and those who were children. The primary outcome was death or removal from the waitlist due to clinical deterioration. We compared waitlist survival using competing risk analysis. Between 1987 and 2016, there were 7412 patients listed for liver transplant due to AIH, 8119 for PBC, and 10,901 for PSC. Patients with AIH were younger, more likely to be diabetic, and had higher listing model for end-stage liver disease (MELD) scores compared to PBC and PSC patients. Patients with PBC and AIH were more likely to be removed from the waitlist due to death or clinical deterioration. On competing risk analysis, AIH patients had a similar risk of being removed from the waitlist compared to those with PBC (subdistribution hazard ratio (SHR) 0.94, 95% CI 0.85-1.03) and higher risk of removal compared to those with PSC (SHR 0.8, 95% CI 0.72 to 0.89). Autoimmune hepatitis carries a similar risk of waitlist removal to PBC and a higher risk than PSC. The etiology of this disparity is not entirely clear and deserves further investigation.
Sections du résumé
BACKGROUND
BACKGROUND
Outcomes on the liver transplant waitlist can vary by etiology. Our aim is to investigate differences in waitlist mortality of autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) using the United Network for Organ Sharing (UNOS) database.
METHODS
METHODS
We identified patients who were listed for liver transplantation from 1987 to 2016 with a primary diagnosis of AIH, PBC, or PSC. We excluded patients with overlap syndromes, acute hepatic necrosis, missing data, and those who were children. The primary outcome was death or removal from the waitlist due to clinical deterioration. We compared waitlist survival using competing risk analysis.
RESULTS
RESULTS
Between 1987 and 2016, there were 7412 patients listed for liver transplant due to AIH, 8119 for PBC, and 10,901 for PSC. Patients with AIH were younger, more likely to be diabetic, and had higher listing model for end-stage liver disease (MELD) scores compared to PBC and PSC patients. Patients with PBC and AIH were more likely to be removed from the waitlist due to death or clinical deterioration. On competing risk analysis, AIH patients had a similar risk of being removed from the waitlist compared to those with PBC (subdistribution hazard ratio (SHR) 0.94, 95% CI 0.85-1.03) and higher risk of removal compared to those with PSC (SHR 0.8, 95% CI 0.72 to 0.89).
CONCLUSION
CONCLUSIONS
Autoimmune hepatitis carries a similar risk of waitlist removal to PBC and a higher risk than PSC. The etiology of this disparity is not entirely clear and deserves further investigation.
Identifiants
pubmed: 31979326
pii: jcm9020319
doi: 10.3390/jcm9020319
pmc: PMC7074547
pii:
doi:
Types de publication
Journal Article
Langues
eng
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Best Pract Res Clin Gastroenterol. 2011 Dec;25(6):765-82
pubmed: 22117641
Liver Transpl. 2013 Mar;19(3):250-8
pubmed: 23213009
Hepatology. 2010 Jun;51(6):2193-213
pubmed: 20513004
Hepatology. 2012 Feb;55(2):522-9
pubmed: 21994151
HPB (Oxford). 2018 Oct;20(10):916-924
pubmed: 29937419
Clin Gastroenterol Hepatol. 2018 Feb;16(2):278-287.e7
pubmed: 28993258
N Engl J Med. 1994 May 12;330(19):1342-7
pubmed: 8152446
Transplantation. 2019 Jan;103(1):113-121
pubmed: 29985186
Liver Transpl. 2011 Nov;17(11):1355-63
pubmed: 21837735
Am J Transplant. 2015 Jan;15 Suppl 2:1-28
pubmed: 25626341
Clin Liver Dis. 2016 Feb;20(1):191-203
pubmed: 26593299
Liver Res. 2017 Dec;1(4):221-230
pubmed: 29977644
Transpl Int. 2017 May;30(5):454-462
pubmed: 27754570