Childhood autoimmune liver disease: indications and outcome of liver transplantation
| Autor: | Deirdre Kelly, Pei Fan Chai, Rachel M. Brown, Jo L. McPartland, Katharine Foster, Way Seah Lee, Patrick J. McKiernan |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Graft Rejection
Male medicine.medical_specialty medicine.medical_treatment Cholangitis Sclerosing Autoimmune hepatitis Liver transplantation Gastroenterology Tacrolimus Primary sclerosing cholangitis Recurrence Internal medicine Medicine Humans Aspartate Aminotransferases Child Survival rate Retrospective Studies Hepatitis biology business.industry Overlap syndrome Alanine Transaminase Syndrome Liver Failure Acute medicine.disease Survival Analysis Liver Transplantation Transplantation Survival Rate Hepatitis Autoimmune Treatment Outcome Alanine transaminase Liver Pediatrics Perinatology and Child Health Immunology biology.protein Cyclosporine Prothrombin Time Female Steroids business Immunosuppressive Agents |
| Zdroj: | Journal of pediatric gastroenterology and nutrition. 50(3) |
| ISSN: | 1536-4801 |
| Popis: | Background: Graft rejection and disease recurrence are well-recognized complications of liver transplantation (LT) for autoimmune hepatitis (AIH) and autoimmune sclerosing cholangitis (AISC). We describe indications and outcome of LT for childhood AIH and AISC. Patients and Methods: Twenty-year retrospective review of a cohort of children (n = 101) with AIH, AISC, or AIH/sclerosing cholangitis overlap syndrome from a single center. Results: AIH type 1 (AIH1, n 67) was more common than AIH type 2 (AIH2, n 18), AISC (n = 8), or overlap syndrome (n = 8). Overall, 18 patients (18) required LT, the indications being failure of medical therapy (n = 16) and fulminant liver failure (n = 2). Patients with AIH who required LT had a more prolonged prothrombin time at presentation compared with those who did not undergo transplantation (P = 0.01). Patients with AIH1 who received LT had a lower aspartate transaminase (P - 0.009) and alanine transaminase (P = 0.02) levels at initial diagnosis compared with those with AIH1 who did not undergo transplantation. Post-LT, 11 patients (61) had 18 episodes of rejection, most were steroid sensitive. Disease recurrence was observed in 7 patients (39, median duration post-LT 33 months), more common in AIH2 (80 recurrence rate), and those taking cyclosporine (71, 5/7 patients) compared with those taking tacrolimus (18, 2/11 patients; P< 0.05) and in 3 of 3 children who did not have maintenance steroids post-LT. The overall 5- and 7-year post-LT survival rate was 94 and 88, respectively. Conclusions: LT is a good therapeutic option for progressive AIH and AISC, although recurrence of the primary autoimmune process limits the outcome. |
| Databáze: | OpenAIRE |
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