Childhood autoimmune liver disease: indications and outcome of liver transplantation

Chai, P.F. and Lee, Way Seah and Brown, R.M. and McPartland, J.L. and Foster, K. and McKiernan, P.J. and Kelly, D.A. (2010) Childhood autoimmune liver disease: indications and outcome of liver transplantation. Journal of Pediatric Gastroenterology and Nutrition, 50 (3). pp. 295-302. ISSN 0277-2116, DOI

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Background: Graft rejection and disease recurrence are well-recognized complications of liver transplantation (LT) for autoimmune hepatitis (AIH) and autoimmune sclerosing cholangitis (AISC). We describe indications and outcome of LT for childhood AIH and AISC. Patients and Methods: Twenty-year retrospective review of a cohort of children (n = 101) with AIH, AISC, or AIH/sclerosing cholangitis overlap syndrome from a single center. Results: AIH type 1 (AIH1, n 67) was more common than AIH type 2 (AIH2, n 18), AISC (n = 8), or overlap syndrome (n = 8). Overall, 18 patients (18) required LT, the indications being failure of medical therapy (n = 16) and fulminant liver failure (n = 2). Patients with AIH who required LT had a more prolonged prothrombin time at presentation compared with those who did not undergo transplantation (P = 0.01). Patients with AIH1 who received LT had a lower aspartate transaminase (P - 0.009) and alanine transaminase (P = 0.02) levels at initial diagnosis compared with those with AIH1 who did not undergo transplantation. Post-LT, 11 patients (61) had 18 episodes of rejection, most were steroid sensitive. Disease recurrence was observed in 7 patients (39, median duration post-LT 33 months), more common in AIH2 (80 recurrence rate), and those taking cyclosporine (71, 5/7 patients) compared with those taking tacrolimus (18, 2/11 patients; P< 0.05) and in 3 of 3 children who did not have maintenance steroids post-LT. The overall 5- and 7-year post-LT survival rate was 94 and 88, respectively. Conclusions: LT is a good therapeutic option for progressive AIH and AISC, although recurrence of the primary autoimmune process limits the outcome.

Item Type: Article
Uncontrolled Keywords: Autoimmune liver disease; childhood; liver transplant; primary sclerosing cholangitis; ursodeoxycholic acid; allograft-rejection; overlap syndrome; hepatitis
Subjects: R Medicine
R Medicine > RJ Pediatrics
Divisions: Faculty of Medicine
Depositing User: Ms Haslinda Lahuddin
Date Deposited: 13 Jul 2014 06:29
Last Modified: 21 Mar 2019 06:47

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