Recurrence of autoimmune hepatitis cholestatic variant syndromes after liver transplantation affects graft and patient survival in an international multicentre cohort
Recommended Citation
Ronca V, Parente A, Lytvyak E, Hansen B, Hirschfield GM, Bonder A, Ebadi M, Elwir S, Alsaed M, Milkiewicz P, Janik M, Marschall H, Burza MA, Efe C, Caliskan AR, Harputluoglu M, Kabaçam G, Terrabuio DR, Onofrio F, Selzner N, Pares A, Llovet LP, Akyildiz M, Arıkan C, Manns MP, Taubert R, Weber A, Schiano T, Haydel B, Czubkowski P. Recurrence of autoimmune hepatitis cholestatic variant syndromes after liver transplantation affects graft and patient survival in an international multicentre cohort. J Hepatol 2024; 80:S374-S375.
Document Type
Conference Proceeding
Publication Date
6-1-2024
Publication Title
J Hepatol
Abstract
Background and aims: A significant proportion of patients with variant syndromes (VS), namely AIH PBC or AIH PSC require liver transplantation (LT), despite treatment. The frequency of disease recurrence and the effect on graft survival is yet to be clarified. The aim of this international, multicentric, retrospective study is to evaluate risk factors associated with recurrence and the impact of the disease recurrence after LT on graft and patient survival. Method: We evaluated 172 patients undergoing LT for VS in 33 centres 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 analysed to identify patients with a higher risk of recurrence of autoimmune disease based on histological and radiological diagnosis. Cumulative probabilities of graft and overall survival after LT were calculated using semi-Markov model. Results: VS recurred after LT in 23% and 33% of patients after 5 and 10 years, respectively. An increased ALP and ALT at 12 months after LT (HR, 1.60; 95% CI, 1.13–2.25; p < 0.01, HR, 1.25; 95% CI, 1.01–1.53; p = 0.03) and acute rejection (HR 3.58; 95% CI, 1.60–7.73; p < 0.01) were found associated with a higher risk of VS syndrome recurrence, whilst the use of predniso (lo)ne was associated with a reduced risk (HR 0.30, 95% CI 0.14–0.64, p < 0.01). After adjusting for ALTand ALP at 12-months, the use of predniso (lo)ne was found to be independently and negatively associated with recurrent disease. The recurrence of VS was found significantly associated with graft loss and patients’ survival at the multivariate Cox regression analysis with timedependent covariate. The 5-, 10- year probability of graft survival was 68% and 41% in patients with recurrent VS compared to 83% and 60% in patients without recurrent disease (p value, p = 0.01). The overall survival was significantly reduced in patients with recurrent disease (p = 0.01), with event probability at 5- and 10- years of 75% and 49 no% vs 84% and 60% in patients without recurrence. Conclusion: VS recurrence after LT is frequent and is associated with elevation of liver enzymes within the first year after LT and rejection episodes. VS recurrence negatively impacts graft and patient survival. Strategies are warrant to prevent VS recurrence or mitigate its negative effects.
Volume
80
First Page
S374
Last Page
S375
