Autoimmune hepatitis - primary biliary cholangitis overlap syndrome. Long-term outcomes of a retrospective cohort in a university hospital.

Autor:	Martínez Casas OY; Hepatología Clínica, Universidad de Antioquia, Medellín, Colombia. Electronic address: omryesmed42@gmail.com., Díaz Ramírez GS; Hepatología Clínica, Universidad de Antioquia, Medellín, Colombia., Marín Zuluaga JI; Grupo Gastrohepatología, Universidad de Antioquia, Medellín, Colombia; Unidad de Hepatología y Trasplante Hepático, Hospital Pablo Tobón Uribe, Medellín, Colombia., Santos Ó; Grupo Gastrohepatología, Universidad de Antioquia, Medellín, Colombia; Unidad de Hepatología y Trasplante Hepático, Hospital Pablo Tobón Uribe, Medellín, Colombia., Muñoz Maya O; Grupo Gastrohepatología, Universidad de Antioquia, Medellín, Colombia; Unidad de Hepatología y Trasplante Hepático, Hospital Pablo Tobón Uribe, Medellín, Colombia., Donado Gómez JH; Grupo Gastrohepatología, Universidad de Antioquia, Medellín, Colombia; Unidad de Epidemiología, Hospital Pablo Tobón Uribe, Medellín, Colombia., Restrepo Gutiérrez JC; Grupo Gastrohepatología, Universidad de Antioquia, Medellín, Colombia; Unidad de Hepatología y Trasplante Hepático, Hospital Pablo Tobón Uribe, Medellín, Colombia.
Jazyk:	English; Spanish; Castilian
Zdroj:	Gastroenterologia y hepatologia [Gastroenterol Hepatol] 2018 Nov; Vol. 41 (9), pp. 544-552. Date of Electronic Publication: 2018 Jul 13.
DOI:	10.1016/j.gastrohep.2018.05.019
Abstrakt:	Background: Autoimmune hepatitis (AIH) with characteristics of primary biliary cholangitis (PBC) is known as overlap syndrome. Its prevalence and prognosis have not yet been determined comparatively with AIH. Methods: A retrospective cohort study was conducted comparing patients diagnosed with AIH and AIH-PBC overlap syndrome, followed-up for seven years in a university hospital in Colombia, until 31 December 2016. Results: A total of 210 patients were included (195 women, mean age 48.5years). Of these, 32 (15.2%) had AIH-PBC overlap syndrome. At diagnosis, no significant differences were found by demographic profile, positive autoantibodies (ANA, ASMA), except AMA (81.2% vs 3.9%, P<.001), and histological grade of fibrosis. The most frequent clinical presentations were nonspecific symptoms in AIH-PBC and acute hepatitis in AIH. Although there were no significant differences, AIH showed a greater biochemical response to immunosuppressive management (87.3% vs 74.2%, P=.061) and a greater number of relapses in those who achieved partial or complete remission during treatment (12.4% vs 7.63%; P=.727). Patients with AIH-PBC had greater progression to cirrhosis (22.2% vs 13.1%, P=.038), even in those who achieved partial or complete biochemical remission without relapse, with greater indication of orthotopic liver transplantation (P=.009), but not retransplantation (P=.183); there were no differences in mortality. Conclusions: AIH-PBC overlap syndrome accounts for a significant proportion of patients with AIH, with greater progression to cirrhosis, indication of liver transplantation and possibly retransplantation. This higher risk of adverse outcomes suggests closer monitoring, probably with follow-up until confirmed histopathological remission. (Copyright © 2018 Elsevier España, S.L.U. All rights reserved.)
Databáze:	MEDLINE
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