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Racial disparities in presentation and outcomes of paediatric autoimmune hepatitis

Sirish K Palle1,2, Kushal B Naik1,3, Courtney E McCracken2

  • 1Transplant Services, Children's Healthcare of Atlanta (CHOA), Atlanta, Georgia.

Liver International : Official Journal of the International Association for the Study of the Liver
|February 26, 2019
PubMed

Insights

Pediatric autoimmune hepatitis (AIH) in African American (AA) children presents with more severe disease, higher transplant risk, and increased recurrence post-transplant compared to non-AA children. Further research into underlying factors is crucial.

Area of Science:

  • Pediatric Hepatology
  • Autoimmune Diseases
  • Transplantation Immunology

Background:

  • Autoimmune hepatitis (AIH) studies in children predominantly feature Caucasian cohorts.
  • Pediatric AIH in African Americans (AA) is understudied, lacking predictors for outcomes and often leading to severe complications or mortality.

Purpose of the Study:

  • To define disease presentation, progression, therapy response, and outcomes in pediatric AIH within a diverse, single-center cohort.
  • To identify clinical predictors of outcome in African American children with AIH.

Main Methods:

  • Retrospective review of pediatric AIH patients at a tertiary liver transplant center.
  • Assessment of clinical and laboratory data to compare disease presentation, progression, and outcomes between AA and non-AA children.

Main Results:

  • African Americans comprised 42% of the cohort; they received higher steroid doses and presented more frequently with end-stage liver disease (ESLD).
  • AA children faced a 4.5-fold higher risk of liver transplant or death within 12 months.
  • Post-transplant AIH recurrence was significantly higher in AA (50%) versus non-AA (8%) patients.

Conclusions:

  • African American pediatric AIH patients exhibit a higher likelihood of presenting with ESLD and face increased early transplant risk.
  • Disease recurrence post-transplantation is a significant concern in AA children with AIH.
  • Further studies are needed to explore biological, genetic, and access-to-care factors; early referral and tailored immunosuppression are recommended for AA patients.
Abstract

Keywords:
African Americanautoimmune diseaseimmunosuppressive therapypaediatrics

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