Keeling Stephanie S, McDonald Malcolm F, Anand Adrish, Goff Cameron R, Christmann Caroline R, Barrett Spencer C, Kueht Michael, Goss John A, Cholankeril George, Rana Abbas
Department of Student Affairs, Baylor College of Medicine, Houston, TX 77030, USA.
Medical Scientist Training Program, Baylor College of Medicine, Houston, TX 77030, USA.
J Pers Med. 2022 Jul 17;12(7):1159. doi: 10.3390/jpm12071159.
Orthotopic liver transplantation (OLT) is a lifesaving therapy for patients with irreversible liver damage caused by autoimmune liver diseases (AutoD) including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC). Currently, it is unclear how access to transplantation differs among patients with various etiologies of liver disease. Our aim is to evaluate the likelihood of transplant and the long-term patient and graft survival after OLT for each etiology for transplantation from 2000 to 2021. We conducted a large retrospective study of United Network for Organ Sharing (UNOS) liver transplant patients in five 4-year eras with five cohorts: AutoD (PBC, PSC, AIH cirrhosis), alcohol-related liver disease (ALD), hepatocellular carcinoma (HCC), viral hepatitis, and nonalcoholic steatohepatitis (NASH). We conducted a multivariate analysis for probability of transplant. Intent-to-treat (ITT) analysis was performed to assess the 10-year survival differences for each listing diagnosis while accounting for both waitlist and post-transplant survival. Across all eras, autoimmune conditions had a lower adjusted probability of transplant of 0.92 (0.92, 0.93) compared to ALD 0.97 (0.97, 0.97), HCC 1.08 (1.07, 1.08), viral hepatitis 0.99 (0.99, 0.99), and NASH 0.99 (0.99, 1.00). Patients with AutoD had significantly better post-transplant patient and graft survival than ALD, HCC, viral hepatitis, and NASH in each and across all eras (p-values all < 0.001). Patients with AutoD had superior ITT survival (p-value < 0.001, log rank test). In addition, the waitlist survival for patients with AutoD compared to other listing diagnoses was improved with the exception of ALD, which showed no significant difference (p-value = 0.1056, log rank test). Despite a superior 10-year graft and patient survival in patients transplanted for AutoD, patients with AutoD have a significantly lower probability of receiving a liver transplant compared to those transplanted for HCC, ALD, viral hepatitis, and NASH. Patients with AutoD may benefit from improved liver allocation while maintaining superior waitlist and post-transplant survival. Decreased access in spite of appropriate outcomes for patients poses a significant risk for increased morbidity for patients with AutoD.
原位肝移植（OLT）是一种挽救生命的治疗方法，适用于患有自身免疫性肝病（AutoD）导致的不可逆肝损伤的患者，包括自身免疫性肝炎（AIH）、原发性胆汁性胆管炎（PBC）和原发性硬化性胆管炎（PSC）。目前，尚不清楚不同病因肝病患者获得移植的情况有何差异。我们的目的是评估2000年至2021年期间，每种移植病因进行OLT后的移植可能性以及患者和移植物的长期生存率。我们对器官共享联合网络（UNOS）的肝移植患者进行了一项大型回顾性研究，分为五个4年时间段和五个队列：AutoD（PBC、PSC、AIH肝硬化）、酒精性肝病（ALD）、肝细胞癌（HCC）、病毒性肝炎和非酒精性脂肪性肝炎（NASH）。我们对移植概率进行了多变量分析。进行意向性治疗（ITT）分析，以评估每个登记诊断的10年生存率差异，同时考虑等待名单和移植后的生存率。在所有时间段中，与ALD的0.97（0.97, 0.97）、HCC的1.08（1.07, 1.08）、病毒性肝炎的0.99（0.99, 0.99）和NASH的0.99（0.99, 1.00）相比，自身免疫性疾病患者调整后的移植概率较低，为0.92（0.92, 0.93）。在每个时间段以及所有时间段中，AutoD患者移植后的患者和移植物生存率均显著高于ALD、HCC、病毒性肝炎和NASH（所有p值均<0.001）。AutoD患者的ITT生存率更高（p值<0.001，对数秩检验）。此外，与其他登记诊断相比，AutoD患者的等待名单生存率有所提高，但ALD除外，ALD无显著差异（p值 = 0.1056，对数秩检验）。尽管因AutoD进行移植的患者10年移植物和患者生存率更高，但与因HCC、ALD、病毒性肝炎和NASH进行移植的患者相比，AutoD患者接受肝移植的概率显著更低。AutoD患者可能受益于改善肝脏分配，同时保持较好的等待名单和移植后生存率。尽管患者有合适的治疗结果，但获得移植的机会减少对AutoD患者增加发病率构成了重大风险。
