北美单中心自身免疫性肝炎肝移植经验：虽为罕见适应症，但患者预后良好。
Single-Center North American Experience of Liver Transplantation in Autoimmune Hepatitis: Infrequent Indication but Good Outcomes for Patients.
作者信息
de Quadros Onofrio Fernanda, Neong Evon, Adebayo Danielle, Kollmann Dagmar, Adeyi Oyedele Adewale, Fischer Sandra, Hirschfield Gideon Morris, Hansen Bettina Elisabeth, Bhat Mamatha, Galvin Zita, Lilly Leslie Blake, Selzner Nazia
机构信息
Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada.
Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.
出版信息
J Can Assoc Gastroenterol. 2020 Jul 20;4(3):137-144. doi: 10.1093/jcag/gwaa022. eCollection 2021 Jun.
BACKGROUND AND AIMS
A 40% risk of disease recurrence post-liver transplantation (LT) for autoimmune hepatitis (AIH) has been previously reported. Risk factors for recurrence and its impact on long-term patient outcome are poorly defined. We aimed to assess prevalence, time to disease recurrence, as well as patient and graft survival in patients with recurrent AIH (rAIH) versus those without recurrence.
METHODS
Single-center retrospective study of adult recipients who underwent LT for AIH between January 2007 and December 2017. Patients with AIH overlap syndromes were excluded.
RESULTS
A total of 1436 LTs were performed during the study period, of whom 46 (3%) for AIH. Eight patients had AIH overlap syndromes and were excluded. Patients were followed up for 4.4 ± 3.4 years and mean age at LT was 46.8 years. Average transplant MELD (Model for End-Stage Liver Disease) score was 24.9. About 21% of patients (8 of 38) were transplanted for acute onset of AIH; 66% of patients ( = 25) received a deceased donor liver graft, and 34% a living donor organ. rAIH occurred in 7.8% ( = 3/38) of recipients. Time to recurrence was 1.6, 12.2 and 60.7 months. Patient and graft survival in patients without recurrence was 88.6% and 82.8% in 5 years, whereas in those with rAIH, it was 66.7%, respectively.
CONCLUSION
Although AIH recurs post-LT, our data indicate a lower recurrence rate when compared to the literature and excellent patient and graft survival.
背景与目的
先前报道，自身免疫性肝炎（AIH）患者肝移植（LT）后疾病复发风险为40%。复发的危险因素及其对患者长期预后的影响尚不明确。我们旨在评估复发性AIH（rAIH）患者与未复发患者的疾病复发率、复发时间以及患者和移植物生存率。
方法
对2007年1月至2017年12月期间因AIH接受LT的成年受者进行单中心回顾性研究。排除患有AIH重叠综合征的患者。
结果
研究期间共进行了1436例肝移植，其中46例（3%）为AIH患者。8例患者患有AIH重叠综合征，被排除在外。患者随访4.4±3.4年，LT时的平均年龄为46.8岁。平均移植终末期肝病模型（MELD）评分为24.9。约21%的患者（38例中的8例）因AIH急性发作接受移植；66%的患者（n=25）接受了尸体供肝移植，34%接受了活体供肝移植。rAIH发生在7.8%（n=3/38）的受者中。复发时间分别为1.6个月、12.2个月和60.7个月。未复发患者的5年患者生存率和移植物生存率分别为88.6%和82.8%，而rAIH患者分别为66.7%。
结论
尽管AIH在LT后会复发，但我们的数据表明，与文献报道相比，复发率较低，患者和移植物生存率良好。
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