Primary liver transplantation for autoimmune hepatitis: a comparative analysis of the European Liver Transplant Registry.
The principal aim of this study was to compare the probability of and potential risk factors for death and graft loss after primary adult and pediatric liver transplantation in patients undergoing transplantation for autoimmune hepatitis (AIH) to those in patients undergoing transplantation for primary biliary cirrhosis (PBC; used as the reference group) or alcoholic cirrhosis (used as an example of a nonautoimmune liver disease). The 5-year survival of patients undergoing transplantation for AIH (n = 827) was 0.73 [95% confidence interval (CI) = 0.67-0.77]. This was similar to that of patients undergoing transplantation for alcoholic cirrhosis (0.74, 95% CI = 0.72-0.76, n = 6424) but significantly worse than that of patients undergoing transplantation for PBC (0.83, 95% CI = 0.80-0.85, n = 1588). Fatal infectious complications occurred at an increased rate in patients with AIH (hazard ratio = 1.8, P = 0.002 with PBC as the reference). The outcome of pediatric AIH patients was similar to that of adult patients undergoing transplantation up to the age of 50 years. However, the survival of AIH patients undergoing transplantation beyond the age of 50 years (0.61 at 5 years, 95% CI = 0.51-0.70) was significantly reduced in comparison with the survival of young adult AIH patients (0.78 at 18-34 years, 95% CI = 0.70-0.86) and in comparison with the survival of patients of the same age group with PBC or alcoholic cirrhosis. In conclusion, age significantly affects patient survival after liver transplantation for AIH. The increased risk of dying of infectious complications in the early postoperative period, especially above the age of 50 years, should be acknowledged in the management of AIH patients with advanced-stage liver disease who are listed for liver transplantation. It should be noted that not all risk factors relevant to patient and graft survival could be analyzed with the European Liver Transplant Registry database.
Schramm
Christoph
C
Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. cschramm@uke.de
Bubenheim
Michael
M
Adam
René
R
Karam
Vincent
V
Buckels
John
J
O'Grady
John G
JG
Jamieson
Neville
N
Pollard
Stephen
S
Neuhaus
Peter
P
Manns
Michael M
MM
Porte
Robert
R
Castaing
Denis
D
Paul
Andreas
A
Traynor
Oscar
O
Garden
James
J
Friman
Styrbjörn
S
Ericzon
Bo-Goran
BG
Fischer
Lutz
L
Vitko
Stefan
S
Krawczyk
Marek
M
Metselaar
Herold J
HJ
Foss
Aksel
A
Kilic
Murat
M
Rolles
Keith
K
Burra
Patrizia
P
Rogiers
Xavier
X
Lohse
Ansgar W
AW
D000293:Adolescent; D000328:Adult; D005060:Europe; D005260:Female; D019693:Hepatitis, Autoimmune / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007511:Ischemia; D008099:Liver / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome