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Adult and pediatric liver transplantation for autoimmune hepatitis
T G Heffron1, G A Smallwood, B Oakley
1Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Insights
Liver transplant outcomes differ between adult and pediatric patients with autoimmune hepatitis (AIH). Pediatric patients face higher risks of colitis and longer hospital stays, while adults are more likely to be weaned from steroids.
Area of Science:
- Hepatology
- Transplantation Immunology
- Pediatric Gastroenterology
Background:
- Autoimmune hepatitis (AIH) is a chronic liver disease.
- Liver transplantation is a treatment option for end-stage liver disease due to AIH.
- Pediatric AIH patients often undergo transplantation at a younger age, potentially influencing post-transplant outcomes compared to adults.
Purpose of the Study:
- To compare liver transplant outcomes between adult and pediatric patients with autoimmune hepatitis.
- To identify differences in rejection rates, disease recurrence, and associated complications.
Main Methods:
- Retrospective review of adult and pediatric liver transplant programs.
- Inclusion of 56 patients diagnosed with autoimmune hepatitis.
- Biopsy-confirmed diagnosis for rejection and AIH recurrence.
Main Results:
- Patients experiencing rejection had a 1.76-fold increased risk of AIH recurrence.
- Pediatric recipients showed a 6.62-fold increased risk of developing colitis post-transplant.
- Pediatric patients had significantly longer hospitalizations (51.7 days) compared to adults (20.5 days).
- Mean time to AIH recurrence was similar between groups.
Conclusions:
- Pediatric liver transplant recipients with AIH are at higher risk for ulcerative colitis and prolonged hospital stays.
- Adult AIH patients demonstrated a greater likelihood of successful steroid weaning post-transplant.
- AIH recurrence was not associated with steroid weaning in this cohort.
Background:
Due to the early age that pediatric patients with autoimmune hepatitis (AIH) are transplanted, it is theorized that older AIH patients may have different outcomes than pediatric patients following liver transplantation.
Methods:
This is a retrospective review of both the adult and pediatric liver transplant programs consisting of 56 patients. Rejection and recurrence of AIH were determined by biopsy.
Results:
The autoimmune patient having rejection episodes had a 1.76-fold increase in relative risk to develop autoimmune recurrence when compared to patients without rejection [RR = 1.76; 95% CIRR (1.08, 2.86)]. The pediatric group had a 6.62-fold increase in relative risk to develop colitis following liver transplantation [RR = 6.62; 95% C.I.R.R. (1.36, 32.13); P =.02]. Mean days to recurrence of AIH were similar in both groups (1364 +/- 1074 vs 936; P = NS). There were more hospitalized days in the pediatric group compared to the adults (20.5 +/- 13.3 days vs 51.7 +/- 22.2 days, P =.039). OKT-3 was rarely used (n = 5) in either group (9.3% vs 7.7%, P = NS) and was not correlated with which patients would be weaned from steroids or recurrence.
Conclusions:
Based on this review, pediatric patients were more likely to develop ulcerative colitis following liver transplantation and they incurred longer hospital stays than adults. The adult group was more likely to be weaned from steroids, with AIH recurrence unrelated to weaning.
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