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Primary liver transplantation for autoimmune hepatitis: A comparative analysis of the European Liver Transplant Registry
Author(s) -
Schramm Christoph,
Bubenheim Michael,
Adam René,
Karam Vincent,
Buckels John,
O'Grady John G.,
Jamieson Neville,
Pollard Stephen,
Neuhaus Peter,
Manns Michael M.,
Porte Robert,
Castaing Denis,
Paul Andreas,
Traynor Oscar,
Garden James,
Friman Styrbjörn,
Ericzon BoGoran,
Fischer Lutz,
Vitko Stefan,
Krawczyk Marek,
Metselaar Herold J.,
Foss Aksel,
Kilic Murat,
Rolles Keith,
Burra Patrizia,
Rogiers Xavier,
Lohse Ansgar W.
Publication year - 2010
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.22018
Subject(s) - medicine , autoimmune hepatitis , liver transplantation , transplantation , primary biliary cirrhosis , gastroenterology , hazard ratio , alcoholic liver disease , cirrhosis , liver disease , primary sclerosing cholangitis , confidence interval , hepatitis , surgery , disease
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 AIH. 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 , 2010. © 2010 AASLD.