Primary Liver Transplantation for Autoimmune Hepatitis: A Comparative Analysis of the European Liver Transplant Registry

C Schramm; M Bubenheim; R Adam; V Karam; J Buckels; JG O'Grady; N Jamieson; S Pollard; P Neuhaus; MM Manns; R Porte; D Castaing; A Paul; O Traynor; J Garden; S Friman; BG Ericzon; L Fischer; S Vitko; M Krawczyk; Herold Metselaar; A Foss; Murat Kilic; K Rolles; P Burra; X Rogiers; AW Lohse

doi:10.1002/lt.22018

Primary Liver Transplantation for Autoimmune Hepatitis: A Comparative Analysis of the European Liver Transplant Registry

C Schramm, M Bubenheim, R Adam, V Karam, J Buckels, JG O'Grady, N Jamieson, S Pollard, P Neuhaus, MM Manns, R Porte, D Castaing, A Paul, O Traynor, J Garden, S Friman, BG Ericzon, L Fischer, S Vitko, M KrawczykHerold Metselaar, A Foss, Murat Kilic, K Rolles, P Burra, X Rogiers, AW Lohse

Gastroenterology & Hepatology

Research output: Contribution to journal › Article › Academic › peer-review

71 Citations (Scopus)

Abstract

The principal aim of this study was to compare the probability of and potential risk factors for death and graft loss after primary adult and pediatric liver transplantation in patients undergoing transplantation for autoimmune hepatitis (AIH) to those in patients undergoing transplantation for primary biliary cirrhosis (PBC; used as the reference group) or alcoholic cirrhosis (used as an example of a nonautoimmune liver disease). The 5-year survival of patients undergoing transplantation for AIH (n = 827) was 0.73 [95% confidence interval (CI) = 0.67-0.77]. This was similar to that of patients undergoing transplantation for alcoholic cirrhosis (0.74, 95% CI = 0.72-0.76, n = 6424) but significantly worse than that of patients undergoing transplantation for PBC (0.83, 95% CI = 0.80-0.85, n = 1588). Fatal infectious complications occurred at an increased rate in patients with AIH (hazard ratio = 1.8, P = 0.002 with PBC as the reference). The outcome of pediatric AIH patients was similar to that of adult patients undergoing transplantation up to the age of 50 years. However, the survival of AIH patients undergoing transplantation beyond the age of 50 years (0.61 at 5 years, 95% CI = 0.51-0.70) was significantly reduced in comparison with the survival of young adult AIH patients (0.78 at 18-34 years, 95% CI = 0.70-0.86) and in comparison with the survival of patients of the same age group with PBC or alcoholic cirrhosis. In conclusion, age significantly affects patient survival after liver transplantation for AN. The increased risk of dying of infectious complications in the early postoperative period, especially above the age of 50 years, should be acknowledged in the management of AIH patients with advanced-stage liver disease who are listed for liver transplantation. It should be noted that not all risk factors relevant to patient and graft survival could be analyzed with the European Liver Transplant Registry database. Liver Transpl 16:461-469, 2010. (C) 2010 AASLD.

Original language	Undefined/Unknown
Pages (from-to)	461-469
Number of pages	9
Journal	Liver Transplantation
Volume	16
Issue number	4
DOIs	https://doi.org/10.1002/lt.22018
Publication status	Published - 2010

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10.1002/lt.22018

http://hdl.handle.net/1765/28603

Cite this

Schramm, C., Bubenheim, M., Adam, R., Karam, V., Buckels, J., O'Grady, JG., Jamieson, N., Pollard, S., Neuhaus, P., Manns, MM., Porte, R., Castaing, D., Paul, A., Traynor, O., Garden, J., Friman, S., Ericzon, BG., Fischer, L., Vitko, S., ... Lohse, AW. (2010). Primary Liver Transplantation for Autoimmune Hepatitis: A Comparative Analysis of the European Liver Transplant Registry. Liver Transplantation, 16(4), 461-469. https://doi.org/10.1002/lt.22018

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abstract = "The principal aim of this study was to compare the probability of and potential risk factors for death and graft loss after primary adult and pediatric liver transplantation in patients undergoing transplantation for autoimmune hepatitis (AIH) to those in patients undergoing transplantation for primary biliary cirrhosis (PBC; used as the reference group) or alcoholic cirrhosis (used as an example of a nonautoimmune liver disease). The 5-year survival of patients undergoing transplantation for AIH (n = 827) was 0.73 [95% confidence interval (CI) = 0.67-0.77]. This was similar to that of patients undergoing transplantation for alcoholic cirrhosis (0.74, 95% CI = 0.72-0.76, n = 6424) but significantly worse than that of patients undergoing transplantation for PBC (0.83, 95% CI = 0.80-0.85, n = 1588). Fatal infectious complications occurred at an increased rate in patients with AIH (hazard ratio = 1.8, P = 0.002 with PBC as the reference). The outcome of pediatric AIH patients was similar to that of adult patients undergoing transplantation up to the age of 50 years. However, the survival of AIH patients undergoing transplantation beyond the age of 50 years (0.61 at 5 years, 95% CI = 0.51-0.70) was significantly reduced in comparison with the survival of young adult AIH patients (0.78 at 18-34 years, 95% CI = 0.70-0.86) and in comparison with the survival of patients of the same age group with PBC or alcoholic cirrhosis. In conclusion, age significantly affects patient survival after liver transplantation for AN. The increased risk of dying of infectious complications in the early postoperative period, especially above the age of 50 years, should be acknowledged in the management of AIH patients with advanced-stage liver disease who are listed for liver transplantation. It should be noted that not all risk factors relevant to patient and graft survival could be analyzed with the European Liver Transplant Registry database. Liver Transpl 16:461-469, 2010. (C) 2010 AASLD.",

author = "C Schramm and M Bubenheim and R Adam and V Karam and J Buckels and JG O'Grady and N Jamieson and S Pollard and P Neuhaus and MM Manns and R Porte and D Castaing and A Paul and O Traynor and J Garden and S Friman and BG Ericzon and L Fischer and S Vitko and M Krawczyk and Herold Metselaar and A Foss and Murat Kilic and K Rolles and P Burra and X Rogiers and AW Lohse",

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doi = "10.1002/lt.22018",

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Schramm, C, Bubenheim, M, Adam, R, Karam, V, Buckels, J, O'Grady, JG, Jamieson, N, Pollard, S, Neuhaus, P, Manns, MM, Porte, R, Castaing, D, Paul, A, Traynor, O, Garden, J, Friman, S, Ericzon, BG, Fischer, L, Vitko, S, Krawczyk, M, Metselaar, H, Foss, A, Kilic, M, Rolles, K, Burra, P, Rogiers, X & Lohse, AW 2010, 'Primary Liver Transplantation for Autoimmune Hepatitis: A Comparative Analysis of the European Liver Transplant Registry', Liver Transplantation, vol. 16, no. 4, pp. 461-469. https://doi.org/10.1002/lt.22018

TY - JOUR

T1 - Primary Liver Transplantation for Autoimmune Hepatitis: A Comparative Analysis of the European Liver Transplant Registry

AU - Schramm, C

AU - Bubenheim, M

AU - Adam, R

AU - Karam, V

AU - Buckels, J

AU - O'Grady, JG

AU - Jamieson, N

AU - Pollard, S

AU - Neuhaus, P

AU - Manns, MM

AU - Porte, R

AU - Castaing, D

AU - Paul, A

AU - Traynor, O

AU - Garden, J

AU - Friman, S

AU - Ericzon, BG

AU - Fischer, L

AU - Vitko, S

AU - Krawczyk, M

AU - Metselaar, Herold

AU - Foss, A

AU - Kilic, Murat

AU - Rolles, K

AU - Burra, P

AU - Rogiers, X

AU - Lohse, AW

PY - 2010

Y1 - 2010

N2 - The principal aim of this study was to compare the probability of and potential risk factors for death and graft loss after primary adult and pediatric liver transplantation in patients undergoing transplantation for autoimmune hepatitis (AIH) to those in patients undergoing transplantation for primary biliary cirrhosis (PBC; used as the reference group) or alcoholic cirrhosis (used as an example of a nonautoimmune liver disease). The 5-year survival of patients undergoing transplantation for AIH (n = 827) was 0.73 [95% confidence interval (CI) = 0.67-0.77]. This was similar to that of patients undergoing transplantation for alcoholic cirrhosis (0.74, 95% CI = 0.72-0.76, n = 6424) but significantly worse than that of patients undergoing transplantation for PBC (0.83, 95% CI = 0.80-0.85, n = 1588). Fatal infectious complications occurred at an increased rate in patients with AIH (hazard ratio = 1.8, P = 0.002 with PBC as the reference). The outcome of pediatric AIH patients was similar to that of adult patients undergoing transplantation up to the age of 50 years. However, the survival of AIH patients undergoing transplantation beyond the age of 50 years (0.61 at 5 years, 95% CI = 0.51-0.70) was significantly reduced in comparison with the survival of young adult AIH patients (0.78 at 18-34 years, 95% CI = 0.70-0.86) and in comparison with the survival of patients of the same age group with PBC or alcoholic cirrhosis. In conclusion, age significantly affects patient survival after liver transplantation for AN. The increased risk of dying of infectious complications in the early postoperative period, especially above the age of 50 years, should be acknowledged in the management of AIH patients with advanced-stage liver disease who are listed for liver transplantation. It should be noted that not all risk factors relevant to patient and graft survival could be analyzed with the European Liver Transplant Registry database. Liver Transpl 16:461-469, 2010. (C) 2010 AASLD.

AB - The principal aim of this study was to compare the probability of and potential risk factors for death and graft loss after primary adult and pediatric liver transplantation in patients undergoing transplantation for autoimmune hepatitis (AIH) to those in patients undergoing transplantation for primary biliary cirrhosis (PBC; used as the reference group) or alcoholic cirrhosis (used as an example of a nonautoimmune liver disease). The 5-year survival of patients undergoing transplantation for AIH (n = 827) was 0.73 [95% confidence interval (CI) = 0.67-0.77]. This was similar to that of patients undergoing transplantation for alcoholic cirrhosis (0.74, 95% CI = 0.72-0.76, n = 6424) but significantly worse than that of patients undergoing transplantation for PBC (0.83, 95% CI = 0.80-0.85, n = 1588). Fatal infectious complications occurred at an increased rate in patients with AIH (hazard ratio = 1.8, P = 0.002 with PBC as the reference). The outcome of pediatric AIH patients was similar to that of adult patients undergoing transplantation up to the age of 50 years. However, the survival of AIH patients undergoing transplantation beyond the age of 50 years (0.61 at 5 years, 95% CI = 0.51-0.70) was significantly reduced in comparison with the survival of young adult AIH patients (0.78 at 18-34 years, 95% CI = 0.70-0.86) and in comparison with the survival of patients of the same age group with PBC or alcoholic cirrhosis. In conclusion, age significantly affects patient survival after liver transplantation for AN. The increased risk of dying of infectious complications in the early postoperative period, especially above the age of 50 years, should be acknowledged in the management of AIH patients with advanced-stage liver disease who are listed for liver transplantation. It should be noted that not all risk factors relevant to patient and graft survival could be analyzed with the European Liver Transplant Registry database. Liver Transpl 16:461-469, 2010. (C) 2010 AASLD.

U2 - 10.1002/lt.22018

DO - 10.1002/lt.22018

M3 - Article

C2 - 20373456

SN - 1527-6465

VL - 16

SP - 461

EP - 469

JO - Liver Transplantation

JF - Liver Transplantation

IS - 4

ER -