Autoimmune hepatitis recurrence after liver transplantation: "Les jeux sont faits"

被引：4

作者：

Chouik, Yasmina ^{[1
,2
,3
,23
]}

Corpechot, Christophe ^{[4
]}

Francoz, Claire ^{[5
]}

De Martin, Eleonora ^{[6
]}

Guillaud, Olivier ^{[1
,2
]}

Abergel, Armand ^{[7
]}

Altieri, Mario ^{[8
]}

Barbier, Louise ^{[9
]}

Besch, Camille ^{[10
]}

Chazouilleres, Olivier ^{[4
]}

Conti, Filomena ^{[11
]}

Dharancy, Sebastien ^{[12
]}

Durand, Francois ^{[5
]}

Duvoux, Christophe ^{[13
]}

Gugenheim, Jean ^{[14
]}

Hardwigsen, Jean ^{[15
]}

Hilleret, Marie-Noelle ^{[16
]}

Houssel-Debry, Pauline ^{[17
]}

Kamar, Nassim ^{[18
]}

Minello, Anne ^{[19
]}

Neau-Cransac, Martine ^{[20
]}

Pageaux, Georges-Philippe ^{[21
]}

Radenne, Sylvie ^{[3
]}

Roux, Olivier ^{[5
]}

Saliba, Faouzi ^{[6
]}

Samuel, Didier ^{[6
]}

Vanlemmens, Claire ^{[22
]}

Woehl-Jaegle, Marie-Lorraine ^{[9
]}

Leroy, Vincent ^{[16
]}

Duclos-Vallee, Jean-Charles ^{[6
]}

Dumortier, Jerome ^{[1
,2
,24
]}

机构：

[1] Hop Edouard Herriot, Hosp Civils Lyon, Serv Hepato Gastroenterol, Lyon, France

[2] Univ Claude Bernard Lyon 1, Lyon, France

[3] Hop Croix Rousse, Hosp Civils Lyon, Serv Hepato Gastroenterol, Lyon, France

[4] Sorbonne Univ, Hop St Antoine, Assistance Publ Hop Paris AP HP, Ctr Reference Maladies Inflammatoires Voies Biliai, Paris, France

[5] Univ Paris Diderot, Hop Beaujon, APHP, Serv Hepatol & Transplantat Hepat,INSERM U1149, Clichy, France

[6] Univ Paris Saclay, Hop Paul Brousse, AP HP, Ctr Hepato Biliaire,FHU Hepatinov,Ctr Refer, Villejuif, France

[7] CHU Estaing, Inst Pascal, Med Digest, UCA CNRS SIGMA UMR 6602, Clermont Ferrand, France

[8] Hop Cote de Nacre, Serv Hepatogastroenterol Nutr & Oncol Digest, Caen, France

[9] CHU Tours, Hop Trousseau, Serv Chirurg Digest Oncol & Endocrinienne, Transplantat Hepat, Tours, France

[10] CHRU Hautepierre, Serv Chirurg Hepato Bilio Pancreat & Transplantat, Strasbourg, France

[11] Hop La Pitie Salpetriere, AP HP, Serv Chirurg Digest & Hepato Biliaire, Transplantat Hepat, Paris, France

[12] CHRU Lille, Hop Claude Huriez, Serv Hepatol, Lille, France

[13] Hop Henri Mondor, APHP, Serv Hepatol, Creteil, France

[14] Univ Nice Sophia Antipolis, Hop Univ Nice, Serv Chirurg Digest & Transplantat Hepat, Nice, France

[15] Hop La Timone, APHM, Serv Chirurg Gen & Transplantat Hepat, Marseille, France

[16] Univ Grenoble Alpes, CHU Grenoble Alpes, Serv Hepato Gastroenterol, INSERM U1209, La Tronche, France

[17] Hop Univ Pontchaillou, Serv Hepatol & Transplantat Hepat, Rennes, France

[18] CHU Rangueil, Dept Nephrol & Transplantat Organes, Toulouse, France

[19] Univ Bourgogne Franche Comte, CHU Dijon, Serv Hepato Gastroenterol & Oncol Digest, Inserm EPICAD LNC UMR1231, Dijon, France

[20] CHU Bordeaux, Hop Haut Leveque, Serv Chirurg Hepatobiliaire & Transplantat Hepat, Bordeaux, France

[21] CHU St Eloi, Dept Hepatol & Transplantat Hepat, Montpellier, France

[22] Hop Jean Minjoz, Serv Hepatol & Soins Intens Digest, Besancon, France

[23] Hop Croix Rousse, Serv Hepatol, 103 Gd Rue Croix Rousse, F-69004 Lyon, France

[24] Hop Edouard Herriot, Pavillons G&L, F-69437 Lyon 03, France

来源：

LIVER TRANSPLANTATION | 2024年 / 30卷 / 04期

关键词：

DISEASE RECURRENCE; RISK-FACTORS; FOLLOW-UP; OUTCOMES; ASSOCIATION; REJECTION;

D O I：

10.1097/LVT.0000000000000278

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Autoimmune hepatitis (AIH) may recur after liver transplantation (LT). The aims of this study were to evaluate the incidence and risk factors for recurrent autoimmune hepatitis (rAIH). A multicenter retrospective French nationwide study, including all patients aged >= 16 transplanted for AIH, with at least 1 liver biopsy 1 year after LT, was conducted between 1985 and 2018. Risk factors for rAIH were identified using a multivariate Cox regression model. Three hundred and forty-four patients were included (78.8% women) with a median age at LT of 43.6 years. Seventy-six patients (22.1%) developed recurrence in a median time of 53.6 months (IQR, 14.1-93.2). Actuarial risk for developing rAIH was 41.3% 20 years after LT. In multivariate analysis, the strongest risk factor for rAIH was cytomegalovirus D+/R- mismatch status (HR=2.0; 95% CI: 1.1-3.6; p=0.03), followed by associated autoimmune condition. Twenty-one patients (27.6% of rAIH patients) developed liver graft cirrhosis after rAIH. Independent risk factors for these severe forms of rAIH were young age at LT, IgG levels >20.7 g/L, and LT in the context of (sub)fulminant hepatitis. Immunosuppression, especially long-term maintenance of corticosteroid therapy, was not significantly associated with rAIH. Recurrence of AIH after LT is frequent and may lead to graft loss. Recurrence is more frequent in young patients with active disease at the time of LT, yet systematic corticosteroid therapy does not prevent it.

引用

页码：395 / 411

页数：17

共 42 条

[11]

DONALDSON PT, 1991, HEPATOLOGY, V13, P701, DOI 10.1002/hep.1840130415

[12] A 10 year follow up study of patients transplanted for autoimmune hepatitis:: histological recurrence precedes clinical and biochemical recurrence [J].