Longterm corticosteroid use after liver transplantation for autoimmune hepatitis is safe and associated with a lower incidence of recurrent disease.
Patients transplanted for autoimmune hepatitis (AIH) are at risk of recurrent disease. Our current practice is to maintain long-term low-dose corticosteroids with additional immunosuppressive agents. This study describes the implications on patients' outcomes, sepsis, and osteoporosis. We collected data on patients transplanted between January 1999 and October 2014 in a single center who survived for more than 6 months. AIH recurrence was diagnosed by a combination of histology, raised immunoglobulin G levels, and exclusion of other etiologies. Sepsis was defined as any infection that resulted in significant morbidity or mortality. Osteoporosis was defined as a bone densitometry T score of less than -2.0 or evidence of osteoporosis-related fractures. Outcomes were assessed using Kaplan-Meier survival analysis methods. Seventy-three AIH patients underwent liver transplantation with a median follow-up of 94 months (interquartile range, 55-144). The cohort was mainly Caucasian (78%), female (79%), with type 1 AIH (90%), and a mean age of 43 ± 15 years. Overall survival was 92%, 90%, 86%, and 73%, and regraft-free survival was 86%, 81%, 78%, and 64% at 1, 3, 5, and 10 years, respectively. Five patients developed AIH recurrence, giving recurrence rates of 0%, 4%, 6%, and 11% at 1, 3, 5, and 10 years, respectively. Pneumonia was the most common infection, but gastroenteritis and cholangitis were the most recurrent. Freedom from sepsis was 91%, 82%, 80%, and 63%, and freedom from osteoporosis was 100%, 94%, 82%, and 58% at 1, 3, 5, and 10 years, respectively. Longterm low-dose corticosteroid in combination with other immunosuppressive agents seems to reduce AIH recurrence without jeopardizing patient and graft survival. Sepsis and osteoporosis did not occur more often compared to the published literature on liver transplant recipients.
Liver and Hepatobiliary Unit, University of Birmingham, Birmingham, UK.|Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
Thinesh L
TL
Krishnamoorthy
Liver and Hepatobiliary Unit, University of Birmingham, Birmingham, UK.
Joanna
J
Miezynska-Kurtycz
Wolfson Computer Laboratory, University Hospitals Birmingham, UK.
James
J
Hodson
Liver and Hepatobiliary Unit, University of Birmingham, Birmingham, UK.
Bridget K
BK
Gunson
Liver and Hepatobiliary Unit, University of Birmingham, Birmingham, UK.
James
J
Neuberger
Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.|Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, Szczecin, Poland.
Piotr
P
Milkiewicz
Liver and Hepatobiliary Unit, University of Birmingham, Birmingham, UK.|Centre for Liver Research, National Institute for Health Research Birmingham Liver Biomedical Research Unit, Queen Elizabeth Hospital Birmingham, University of Birmingham, Birmingham, UK.
Ye H
YH
Oo
D000328:Adult; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006084:Graft Rejection / Q000453:epidemiology; D019693:Hepatitis, Autoimmune / Q000453:epidemiology / Q000517:prevention & control* / Q000601:surgery; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015994:Incidence; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced / Q000453:epidemiology; D011183:Postoperative Complications / Q000517:prevention & control*; D011239:Prednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies; D018805:Sepsis / Q000139:chemically induced / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011239:Prednisolone