Premium
Long‐term outcomes of de novo autoimmune hepatitis in pediatric liver transplant recipients
Author(s) -
Ekong Udeme D.,
McKiernan Patrick,
Martinez Mercedes,
Lobritto Steven,
Kelly Deirdre,
Ng Vicky L.,
Alonso Estella M.,
Avitzur Yaron
Publication year - 2017
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.12945
Subject(s) - medicine , gastroenterology , immunosuppression , liver transplantation , cirrhosis , complication , retrospective cohort study , portal hypertension , bile duct , autoimmune hepatitis , hepatitis , surgery , transplantation
The long‐term course and outcome of DAIH is unknown. A retrospective multicenter study assessing associations and long‐term consequences of DAIH developing in a transplanted allograft is presented. Children with DAIH were followed from diagnosis until death, re‐ LT , or transfer of care and for a minimum of 1 year. A total of 31 patients of 1833 (1.7%) LT were identified; 29 followed for a median of 7.1 years (range, 1.6‐15); 52% had no rejection preceding diagnosis of DAIH . Transaminases fell following treatment with steroids and antimetabolites ( ALT 108 vs 39 U/L ( P =.002); AST 112 vs 52 U/L ( P =.003); GGT 72 vs 36 U/L ( P =.03), but this was not universally sustained. Transaminases >2X ULN observed in 38% of patients at last follow‐up; commonly GGT , attributed to bile duct injury and ductopenia. Portal hypertension ( PHT ) was seen in four patients and associated with severe fibrosis and cirrhosis. Re‐ LT occurred in two patients for chronic rejection ( CR ) and uncontrolled PHT with gastrointestinal bleeding, respectively. No deaths from DAIH were reported. DAIH is an uncommon complication following pediatric LT requiring prolonged and augmented immunosuppression. It is associated with continued allograft dysfunction and may lead to bile duct injury, CR , and PHT necessitating re‐ LT .