Long-term outcome of liver transplantation for autoimmune hepatitis: A French nationwide study over 30 years.

Abstract

BACKGROUND & AIMS:

Autoimmune hepatitis (AIH) is a rare indication for liver transplantation (LT). The aims of this study were to evaluate long-term survival after LT for AIH and prognostic factors, especially the impact of recurrent AIH (rAIH).

METHODS:

A multicentre retrospective nationwide study including all patients aged ≥16 transplanted for AIH in France was conducted. Early deaths and retransplantations (≤6 months) were excluded.

RESULTS:

The study population consisted of 301 patients transplanted from 1987 to 2018. Median age at LT was 43 years (IQR, 29.4-53.8). Median follow-up was 87.0 months (IQR, 43.5-168.0). Seventy-four patients (24.6%) developed rAIH. Graft survival was 91%, 79%, 65% at 1, 10 and 20 years respectively. Patient survival was 94%, 84% and 74% at 1, 10 and 20 years respectively. From multivariate Cox regression, factors significantly associated with poorer patient survival were patient age ≥58 years (HR = 2.9; 95% CI, 1.4-6.2; p = 0.005) and occurrence of an infectious episode within the first year after LT (HR = 2.5; 95% CI, 1.2-5.1; p = 0.018). Risk factors for impaired graft survival were: occurrence of rAIH (HR = 2.7; 95% CI, 1.5-5.0; p = 0.001), chronic rejection (HR = 2.9; 95% CI, 1.4-6.1; p = 0.005), biliary (HR = 2.0; 95% CI, 1.2-3.4; p = 0.009), vascular (HR = 1.8; 95% CI, 1.0-3.1; p = 0.044) and early septic (HR = 2.1; 95% CI, 1.2-3.5; p = 0.006) complications.

CONCLUSION:

Our results confirm that survival after LT for AIH is excellent. Disease recurrence and chronic rejection reduce graft survival. The occurrence of an infectious complication during the first year post-LT identifies at-risk patients for graft loss and death.

• Authors: Yasmina Chouik, Olivier Chazouillères, Claire Francoz, Eleonora De Martin, Olivier Guillaud, Armand Abergel, Mario Altieri, Louise Barbier, Camille Besch, Filomena Conti, Christophe Corpechot, Sébastien Dharancy, François Durand, Christophe Duvoux, Jean Gugenheim, Jean Hardwigsen, Marie-Noëlle Hilleret, Pauline Houssel-Debry, Nassim Kamar, Delphine Maucort-Boulch, Anne Minello, Martine Neau-Cransac, Georges-Philippe Pageaux, Sylvie Radenne, Olivier Roux, Faouzi Saliba, Olivier Serée, Didier Samuel, Claire Vanlemmens, Marie-Lorraine Woehl-Jaegle, Vincent Leroy, Jean-Charles Duclos-Vallée, Jérôme Dumortier
• Journal: Liver international : official journal of the International Association for the Study of the Liver (Liver Int) Vol. 43 Issue 5 Pg. 1068-1079 (05 2023) ISSN: 1478-3231 [Electronic] United States
• PMID: 36825353 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2023 The Authors. Liver International published by John Wiley & Sons Ltd.

Chemical References

• Immunosuppressive Agents

Topics

• Humans
• Adult
• Middle Aged
• Liver Transplantation (adverse effects)
• Hepatitis, Autoimmune (etiology)
• Immunosuppressive Agents (therapeutic use)
• Retrospective Studies
• Risk Factors
• Recurrence