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Rejection and Steroid Dependence: Unique Risk Factors in the Development of Pediatric Posttransplant De Novo Autoimmune Hepatitis
Author(s) -
Venick R. S.,
McDiarmid S. V.,
Farmer D. G.,
Gornbein J.,
Martin M. G.,
Vargas J.H.,
Ament M. E.,
Busuttil R. W.
Publication year - 2007
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2006.01717.x
Subject(s) - medicine , autoimmune hepatitis , prednisone , immunosuppression , liver transplantation , gastroenterology , univariate analysis , hepatitis , immunology , transplantation , multivariate analysis
Posttransplant de novo autoimmune hepatitis (d‐AIH) is increasingly described as a long‐term complication after pediatric liver transplantation (LT). d‐AIH is characterized by graft dysfunction, the development of autoimmune antibodies and histologic evidence of hepatitis in liver transplant recipients without previous history of autoimmune liver disease. This study is a matched case‐control, univariate analysis aimed at identifying risk factors for the development of d‐AIH and evaluating response to treatment. From 1984 to 2003, 619 children received 788 LTs at a single center. Forty‐one patients developed d‐AIH and were matched with controls for year of LT, age at time of LT and diagnosis. The following variables were insignificant in the development of d‐AIH: age, gender, race, initial diagnosis, ischemia time, graft type, Epstein‐Barr virus and cytomegalovirus status, HLA typing and primary immunosuppression. Compared to controls, d‐AIH patients were less likely to be on monotherapy immunosuppression or weaned off prednisone at the time of diagnosis. The d‐AIH group relative to the controls had statistically significant greater numbers of rejection episodes. d‐AIH was treated with prednisone and/or MMF in 39 of 41 patients and lead to significant improvements in liver function tests. Thirty‐nine patients are alive at a mean of 4.0 years follow‐up after diagnosis. Three have required retransplantation.