Long-term outcome of liver transplantation for autoimmune hepatitis: A French nationwide study over 30 years.
biliary complication
chronic rejection
recurrence
sepsis
survival
Journal
Liver international : official journal of the International Association for the Study of the Liver
ISSN: 1478-3231
Titre abrégé: Liver Int
Pays: United States
ID NLM: 101160857
Informations de publication
Date de publication:
05 2023
05 2023
Historique:
revised:
14
02
2023
received:
29
10
2022
accepted:
20
02
2023
medline:
17
5
2023
pubmed:
25
2
2023
entrez:
24
2
2023
Statut:
ppublish
Résumé
Autoimmune hepatitis (AIH) is a rare indication for liver transplantation (LT). The aims of this study were to evaluate long-term survival after LT for AIH and prognostic factors, especially the impact of recurrent AIH (rAIH). A multicentre retrospective nationwide study including all patients aged ≥16 transplanted for AIH in France was conducted. Early deaths and retransplantations (≤6 months) were excluded. The study population consisted of 301 patients transplanted from 1987 to 2018. Median age at LT was 43 years (IQR, 29.4-53.8). Median follow-up was 87.0 months (IQR, 43.5-168.0). Seventy-four patients (24.6%) developed rAIH. Graft survival was 91%, 79%, 65% at 1, 10 and 20 years respectively. Patient survival was 94%, 84% and 74% at 1, 10 and 20 years respectively. From multivariate Cox regression, factors significantly associated with poorer patient survival were patient age ≥58 years (HR = 2.9; 95% CI, 1.4-6.2; p = 0.005) and occurrence of an infectious episode within the first year after LT (HR = 2.5; 95% CI, 1.2-5.1; p = 0.018). Risk factors for impaired graft survival were: occurrence of rAIH (HR = 2.7; 95% CI, 1.5-5.0; p = 0.001), chronic rejection (HR = 2.9; 95% CI, 1.4-6.1; p = 0.005), biliary (HR = 2.0; 95% CI, 1.2-3.4; p = 0.009), vascular (HR = 1.8; 95% CI, 1.0-3.1; p = 0.044) and early septic (HR = 2.1; 95% CI, 1.2-3.5; p = 0.006) complications. Our results confirm that survival after LT for AIH is excellent. Disease recurrence and chronic rejection reduce graft survival. The occurrence of an infectious complication during the first year post-LT identifies at-risk patients for graft loss and death.
Sections du résumé
BACKGROUND & AIMS
Autoimmune hepatitis (AIH) is a rare indication for liver transplantation (LT). The aims of this study were to evaluate long-term survival after LT for AIH and prognostic factors, especially the impact of recurrent AIH (rAIH).
METHODS
A multicentre retrospective nationwide study including all patients aged ≥16 transplanted for AIH in France was conducted. Early deaths and retransplantations (≤6 months) were excluded.
RESULTS
The study population consisted of 301 patients transplanted from 1987 to 2018. Median age at LT was 43 years (IQR, 29.4-53.8). Median follow-up was 87.0 months (IQR, 43.5-168.0). Seventy-four patients (24.6%) developed rAIH. Graft survival was 91%, 79%, 65% at 1, 10 and 20 years respectively. Patient survival was 94%, 84% and 74% at 1, 10 and 20 years respectively. From multivariate Cox regression, factors significantly associated with poorer patient survival were patient age ≥58 years (HR = 2.9; 95% CI, 1.4-6.2; p = 0.005) and occurrence of an infectious episode within the first year after LT (HR = 2.5; 95% CI, 1.2-5.1; p = 0.018). Risk factors for impaired graft survival were: occurrence of rAIH (HR = 2.7; 95% CI, 1.5-5.0; p = 0.001), chronic rejection (HR = 2.9; 95% CI, 1.4-6.1; p = 0.005), biliary (HR = 2.0; 95% CI, 1.2-3.4; p = 0.009), vascular (HR = 1.8; 95% CI, 1.0-3.1; p = 0.044) and early septic (HR = 2.1; 95% CI, 1.2-3.5; p = 0.006) complications.
CONCLUSION
Our results confirm that survival after LT for AIH is excellent. Disease recurrence and chronic rejection reduce graft survival. The occurrence of an infectious complication during the first year post-LT identifies at-risk patients for graft loss and death.
Substances chimiques
Immunosuppressive Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1068-1079Informations de copyright
© 2023 The Authors. Liver International published by John Wiley & Sons Ltd.
Références
Hoeroldt B, McFarlane E, Dube A, et al. Long-term outcomes of patients with autoimmune hepatitis managed at a nontransplant center. Gastroenterology. 2011;140(7):1980-1989.
Adam R, Karam V, Cailliez V, et al. 2018 Annual Report of the European Liver Transplant Registry (ELTR) - 50-year evolution of liver transplantation. Transpl Int. 2018;31(12):1293-1317.
Reich DJ, Fiel I, Guarrera JV, et al. Liver transplantation for autoimmune hepatitis. Hepatology. 2000;32(4 Pt 1):693-700.
Molmenti EP, Netto GJ, Murray NG, et al. Incidence and recurrence of autoimmune/alloimmune hepatitis in liver transplant recipients. Liver Transpl. 2002;8(6):519-526.
Ayata G, Gordon FD, Lewis WD, et al. Liver transplantation for autoimmune hepatitis: a long-term pathologic study. Hepatology. 2000;32(2):185-192.
Duclos-Vallee JC, Sebagh M, Rifai K, et al. A 10 year follow up study of patients transplanted for autoimmune hepatitis: histological recurrence precedes clinical and biochemical recurrence. Gut. 2003;52(6):893-897.
Rowe IA, Webb K, Gunson BK, Mehta N, Haque S, Neuberger J. The impact of disease recurrence on graft survival following liver transplantation: a single centre experience. Transpl Int. 2008;21(5):459-465.
Heinemann M, Adam R, Berenguer M, et al. Longterm survival after liver transplantation for autoimmune hepatitis: results from the European Liver Transplant Registry. Liver Transpl. 2020;26(7):866-877.
Montano-Loza AJ, Ronca V, Ebadi M, et al. Risk factors and outcomes associated with recurrent autoimmune hepatitis following liver transplantation. J Hepatol. 2022;77(1):84-97.
Montano-Loza AJ, Mason AL, Ma M, Bastiampillai RJ, Bain VG, Tandon P. Risk factors for recurrence of autoimmune hepatitis after liver transplantation. Liver Transpl. 2009;15(10):1254-1261.
Aberg F, Isoniemi H, Hockerstedt K. Long-term results of liver transplantation. Scand J Surg. 2011;100(1):14-21.
Krishnamoorthy TL, Miezynska-Kurtycz J, Hodson J, et al. Longterm corticosteroid use after liver transplantation for autoimmune hepatitis is safe and associated with a lower incidence of recurrent disease. Liver Transpl. 2016;22(1):34-41.
EASL Clinical Practice Guidelines. Autoimmune hepatitis. J Hepatol. 2015;63(4):971-1004.
Demetris AJ, Bellamy C, Hubscher SG, et al. 2016 comprehensive update of the Banff Working Group on Liver Allograft Pathology: introduction of antibody-mediated rejection. Am J Transplant. 2016;16(10):2816-2835.
Milkiewicz P, Hubscher SG, Skiba G, Hathaway M, Elias E. Recurrence of autoimmune hepatitis after liver transplantation. Transplantation. 1999;68(2):253-256.
Ratziu V, Samuel D, Sebagh M, et al. Long-term follow-up after liver transplantation for autoimmune hepatitis: evidence of recurrence of primary disease. J Hepatol. 1999;30(1):131-141.
Farges O, Saliba F, Farhamant H, et al. Incidence of rejection and infection after liver transplantation as a function of the primary disease: possible influence of alcohol and polyclonal immunoglobulins. Hepatology. 1996;23(2):240-248.
Seiler CA, Dufour JF, Renner EL, et al. Primary liver disease as a determinant for acute rejection after liver transplantation. Langenbecks Arch Surg. 1999;384(3):259-263.
Vogel A, Heinrich E, Bahr MJ, et al. Long-term outcome of liver transplantation for autoimmune hepatitis. Clin Transplant. 2004;18(1):62-69.
Padilla M, Mayorga R, Carrasco F, et al. Liver transplantation for autoimmune hepatitis in Peru: outcomes and recurrence. Ann Hepatol. 2012;11(2):222-227.
Trouillot TE, Shrestha R, Kam I, Wachs M, Everson GT. Successful withdrawal of prednisone after adult liver transplantation for autoimmune hepatitis. Liver Transpl Surg. 1999;5(5):375-380.
Junge G, Neuhaus R, Schewior L, et al. Withdrawal of steroids: a randomized prospective study of prednisone and tacrolimus versus mycophenolate mofetil and tacrolimus in liver transplant recipients with autoimmune hepatitis. Transplant Proc. 2005;37(4):1695-1696.
Satapathy SK, Jones OD, Vanatta JM, et al. Outcomes of liver transplant recipients with autoimmune liver disease using long-term dual immunosuppression regimen without corticosteroid. Transplant Direct. 2017;3(7):e178.
Vierling JM, Kerkar N, Czaja AJ, et al. Immunosuppressive treatment regimens in autoimmune hepatitis: systematic reviews and meta-analyses supporting American Association for the Study of Liver Diseases guidelines. Hepatology. 2020;72(2):753-769.
Abu-Shanab A, Ged Y, Ullah N, Houlihan D, McCormick A. Increased incidence of post-transplant lymphoproliferative disorder in autoimmune liver disease: an Irish national experience. J Clin Exp Hepatol. 2018;8(1):42-49.
Ngu JH, Gearry RB, Frampton CM, Stedman CA. Predictors of poor outcome in patients with autoimmune hepatitis: a population-based study. Hepatology. 2013;57(6):2399-2406.
Carenco C, Assenat E, Faure S, et al. Tacrolimus and the risk of solid cancers after liver transplant: a dose effect relationship. Am J Transplant. 2015;15(3):678-686.
Bardou FN, Guillaud O, Erard-Poinsot D, et al. Tacrolimus exposure after liver transplantation for alcohol-related liver disease: impact on complications. Transpl Immunol. 2019;56:101227.
Donaldson PT, Doherty DG, Hayllar KM, McFarlane IG, Johnson PJ, Williams R. Susceptibility to autoimmune chronic active hepatitis: human leukocyte antigens DR4 and A1-B8-DR3 are independent risk factors. Hepatology. 1991;13(4):701-706.
Caruso C, Candore G, Colonna Romano G, et al. HLA, aging, and longevity: a critical reappraisal. Hum Immunol. 2000;61(9):942-949.
Schramm C, Bubenheim M, Adam R, et al. Primary liver transplantation for autoimmune hepatitis: a comparative analysis of the European Liver Transplant Registry. Liver Transpl. 2010;16(4):461-469.