Chen Chongfa, Ke Ruisheng, Yang Fang, Cai Qiucheng, Liu Jianyong, Huang Xinghua, Chen Jianwei, Xu Fengfeng, Jiang Yi
Department of Hepatobiliary Surgery, Dongfang Hospital, Xiamen University.
Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xiamen University.
Medicine (Baltimore). 2020 May;99(20):e20205. doi: 10.1097/MD.0000000000020205.
Autoimmune liver disease (ALD) is a chronic liver disease caused by immune dysfunction in the body. However, no causative or curative medical treatment with proven efficacy exists to cure ALDs, and liver transplantation (LT) remains the only effective treatment available. However, the problem of recurrence of ALDs (rALDs) still remains after LT, which seriously affects the survival rate of the patients. Therefore, clinicians need to be aware of the risk factors affecting rALDs after LT. Therefore, this meta-analysis aims to define the risk factors for rALDs, which include the recurrence of primary biliary cirrhosis, primary sclerosing cholangitis and autoimmune hepatitis.
A systematic search in Pubmed, Embase, Cochrane library and Web of Science databases was performed from 1980 to 2019. The inclusion criteria were risk factors for developing rALDs after LT. However, case series, case reports, reviews, meta-analysis and studies only including human immunodeficiency virus cases, children, and pregnant patients were excluded.
The electronic database search yielded 1728 results. Sixty-three retrospective cohort studies met the inclusion criteria and 13 were included in the meta-analysis. The final cohort included 5077 patients, and among them, 21.96% developed rALDs. Colectomy before LT, HR 0.59 (95% confidence interval [CI]: 0.37-0.96), cholangiocarcinoma, HR 3.42 (95% CI: 1.88-6.21), multiple episodes of acute cellular rejection, HR 2.07 (95% CI: 1.27-3.37), model for end-stage liver disease score, HR 1.05 (95% CI: 1.02-1.08), use of mycophenolate mofetil, HR 1.46 (95% CI: 1.00-2.12) and the use of cyclosporin A, HR 0.69 (95% CI: 0.49-0.97) were associated with the risk of rprimary sclerosing cholangitis. In addition, the use of tacrolimus, HR 1.73 (95% CI: 1.00-2.99) and cyclosporin A, HR 0.59 (95% CI: 0.39-0.88) were associated with the risk of rALD.
Multiple risk factors for rALDs were identified, such as colectomy before LT, cholangiocacinoma, multiple episodes of acute cellular rejection, model for end-stage liver disease score, and especially the use of mycophenolate mofetil, cyclosporin A and tacrolimus.
自身免疫性肝病（ALD）是一种由机体免疫功能紊乱引起的慢性肝病。然而，目前尚无经证实有效的病因性或治愈性药物治疗方法来治愈ALD，肝移植（LT）仍然是唯一可用的有效治疗方法。然而，LT后ALD复发（rALD）的问题仍然存在，这严重影响了患者的生存率。因此，临床医生需要了解影响LT后rALD的危险因素。因此，本荟萃分析旨在确定rALD的危险因素，其中包括原发性胆汁性肝硬化、原发性硬化性胆管炎和自身免疫性肝炎的复发。
对1980年至2019年期间在PubMed、Embase、Cochrane图书馆和Web of Science数据库进行系统检索。纳入标准为LT后发生rALD的危险因素。然而，病例系列、病例报告、综述、荟萃分析以及仅包括人类免疫缺陷病毒病例、儿童和孕妇的研究被排除。
电子数据库检索产生了1728条结果。63项回顾性队列研究符合纳入标准，其中13项纳入荟萃分析。最终队列包括5077例患者，其中21.96%发生了rALD。LT前进行结肠切除术，风险比（HR）为0.59（95%置信区间[CI]：0.37 - 0.96）；胆管癌，HR为3.42（95%CI：1.88 - 6.21）；多次急性细胞排斥反应，HR为2.07（95%CI：1.27 - 3.37）；终末期肝病模型评分，HR为1.05（95%CI：1.02 - 1.08）；使用霉酚酸酯，HR为1.46（95%CI：1.00 - 2.12）；使用环孢素A，HR为0.69（95%CI：0.49 - 0.97）与原发性硬化性胆管炎复发风险相关。此外，使用他克莫司，HR为1.73（95%CI：1.00 - 2.99）和环孢素A，HR为0.59（95%CI：0.39 - 0.88）与rALD风险相关。
确定了rALD的多个危险因素，如LT前进行结肠切除术、胆管癌、多次急性细胞排斥反应、终末期肝病模型评分，尤其是使用霉酚酸酯、环孢素A和他克莫司。
