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Longterm Survival After Liver Transplantation for Autoimmune Hepatitis: Results From the European Liver Transplant Registry
M. Heinemann, R. Adam, M. Berenguer, D. Mirza, SA. Malek-Hosseini, JG. O'Grady, P. Lodge, J. Pratschke, K. Boudjema, A. Paul, K. Zieniewicz, J. Fronek, KH. Weiss, V. Karam, C. Duvoux, A. Lohse, C. Schramm, all the other contributing centers...
Language English Country United States
Document type Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
PubMed
32112516
DOI
10.1002/lt.25739
Knihovny.cz E-resources
- MeSH
- Hepatitis, Autoimmune * epidemiology surgery MeSH
- Liver Cirrhosis, Biliary * MeSH
- Humans MeSH
- Prospective Studies MeSH
- Registries MeSH
- Cholangitis, Sclerosing * surgery MeSH
- Liver Transplantation * adverse effects MeSH
- Living Donors MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
The aim of this study was to analyze longterm patient and graft survival after liver transplantation for autoimmune hepatitis (AIH-LT) from the prospective multicenter European Liver Transplant Registry. Patient and liver graft survival between 1998 and 2017 were analyzed. Patients after AIH-LT (n = 2515) were compared with patients receiving LT for primary biliary cholangitis (PBC-LT; n = 3733), primary sclerosing cholangitis (PSC-LT; n = 5155), and alcohol-related cirrhosis (AC-LT; n = 19,567). After AIH-LT, patient survival was 79.4%, 70.8%, and 60.3% and graft survival was 73.2%, 63.4%, and 50.9% after 5, 10, and 15 years of follow-up. Overall patient survival was similar to patients after AC-LT (P = 0.44), but worse than after PBC-LT (hazard ratio [HR], 1.48; P < 0.001) and PSC-LT (HR, 1.19; P = 0.002). AIH-LT patients were at increased risk for death (HR, 1.37-1.84; P < 0.001) and graft loss (HR, 1.35-1.80; P < 0.001) from infections compared with all other groups and had a particularly increased risk for lethal fungal infections (HR, 3.38-4.20; P ≤ 0.004). Excluding patients who died within 90 days after LT, risk of death after AIH-LT was superior compared with AC-LT (HR, 0.84; P = 0.004), worse compared with PBC-LT (HR, 1.38; P < 0.001) and similar compared with PSC-LT (P = 0.93). Autoimmune hepatitis (AIH) patients with living donor liver transplantation (LDLT) showed reduced survival compared with patients receiving donation after brain death (HR, 1.96; P < 0.001). In AIH-LT patients, overall survival is inferior to PBC-LT and PSC-LT. The high risk of death after AIH-LT is caused mainly by early fatal infections, including fungal infections. Patients with LDLT for AIH show reduced survival.
1 Department of Medicine University Medical Center Hamburg Eppendorf Hamburg Germany
Avicenna Center for Medicine and Organ Transplant Shiraz University of Medical Sciences Shiraz Iran
Department of General Transplant and Liver Surgery Medical University of Warsaw Warsaw Poland
Department of Hepatobiliary and Digestive Surgery Pontchaillou University Hospital Rennes France
Department of Hepatology and Gastroenterology University Hospital of Henri Mondor Creteil France
Department of HPB Surgery Queen Elizabeth Hospital Birmingham United Kingdom
Department of Internal Medicine 4 University Hospital Heidelberg Heidelberg Germany
Department of Visceral and Transplant Surgery University Hospital Essen Essen Germany
European Reference Network for Hepatological Diseases Hamburg Germany
Hepato Biliary Center AP HP Paul Brousse Hospital University of Paris Sud Villejuif France
King's Liver Transplant Unit King's College Hospital NHS Foundation Trust London United Kingdom
Martin Zeitz Center for Rare Diseases University Medical Centre Hamburg Eppendorf Hamburg Germany
References provided by Crossref.org
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