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肝移植后自身免疫性肝炎的复发:"游戏已经完成"
Yasmina Chouik1,2, Christophe Corpechot3, Claire Francoz4
1Hospices civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-Gastroentérologie, and Université Claude Bernard Lyon 1, Lyon, France.
概括
肝移植 (LT) 后的复发性自身免疫性肝炎 (rAIH) 影响22.1%的患者,20年风险为41.3%. 细胞巨乳病毒不匹配和相关的自身免疫性疾病是RAIH的关键风险因素.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 移植免疫学 移植免疫学
- 自免疫性疾病 自免疫性疾病
背景情况:
- 自免疫性肝炎 (AIH) 可以在肝移植 (LT) 后复发.
- 了解复发发病率和风险因素对于患者管理至关重要.
- 复发性AIH (rAIH) 可能导致移植损失.
研究的目的:
- 为了评估 LT 之后的 rAIH 发病率.
- 为了确定与rAIH发展相关的风险因素.
- 确定导致严重形式的RAIH的因素.
主要方法:
- 全国多中心回顾性研究 (1985-2018).
- 包括为AIH移植的16岁以上的患者,以及LT后的肝活检.
- 多变量考克斯回归分析以确定风险因素.
主要成果:
- 22.1%的患者患有rAIH,其20年精算风险为41.3%.
- 关键的RAIH风险因素包括细胞大脑病毒D+/R-不匹配和相关的自身免疫性疾病.
- 较年轻的年龄在LT,高的IgG水平,和 (亚) 发性肝炎的LT预测严重的RAIH.
结论:
- LT后AIH的复发很常见,可能导致移植性肝硬化.
- 细胞巨乳病毒不匹配和相关的自身免疫性疾病是显著的风险因素.
- 长期的皮质类固醇治疗没有显著地预防RAIH.
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