Long-term survival after liver transplantation for autoimmune hepatitis - results from the European Liver Transplant Registry
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Long-term survival after liver transplantation for autoimmune hepatitis - results from the European Liver Transplant Registry. / Heinemann, Melina; Adam, Rene; Berenguer, Marina; Mirza, Darius; Malek-Hosseini, Seyed Ali; O'Grady, John G; Lodge, Peter; Pratschke, Johann; Boudjema, Karim; Paul, Andreas; Zieniewicz, Krzysztof; Fronek, Jiri; Weiss, Karl Heinz; Karam, Vincent; Duvoux, Christophe; Lohse, Ansgar; Schramm, Christoph.
In: LIVER TRANSPLANT, Vol. 26, No. 7, 07.2020, p. 866-877.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Long-term survival after liver transplantation for autoimmune hepatitis - results from the European Liver Transplant Registry
AU - Heinemann, Melina
AU - Adam, Rene
AU - Berenguer, Marina
AU - Mirza, Darius
AU - Malek-Hosseini, Seyed Ali
AU - O'Grady, John G
AU - Lodge, Peter
AU - Pratschke, Johann
AU - Boudjema, Karim
AU - Paul, Andreas
AU - Zieniewicz, Krzysztof
AU - Fronek, Jiri
AU - Weiss, Karl Heinz
AU - Karam, Vincent
AU - Duvoux, Christophe
AU - Lohse, Ansgar
AU - Schramm, Christoph
N1 - Copyright © 2020 The Authors. Liver Transplantation published by Wiley Periodicals Inc., on behalf of American Association for the Study of Liver Diseases.
PY - 2020/7
Y1 - 2020/7
N2 - The aim of this study was to analyze longterm patient and graft survival after liver transplantation for autoimmune hepatitis (AIH-LT) from the prospective multicenter European Liver Transplant Registry. Patient and liver graft survival between 1998 and 2017 were analyzed. Patients after AIH-LT (n = 2515) were compared with patients receiving LT for primary biliary cholangitis (PBC-LT; n = 3733), primary sclerosing cholangitis (PSC-LT; n = 5155), and alcohol-related cirrhosis (AC-LT; n = 19,567). After AIH-LT, patient survival was 79.4%, 70.8%, and 60.3% and graft survival was 73.2%, 63.4%, and 50.9% after 5, 10, and 15 years of follow-up. Overall patient survival was similar to patients after AC-LT (P = 0.44), but worse than after PBC-LT (hazard ratio [HR], 1.48; P < 0.001) and PSC-LT (HR, 1.19; P = 0.002). AIH-LT patients were at increased risk for death (HR, 1.37-1.84; P < 0.001) and graft loss (HR, 1.35-1.80; P < 0.001) from infections compared with all other groups and had a particularly increased risk for lethal fungal infections (HR, 3.38-4.20; P ≤ 0.004). Excluding patients who died within 90 days after LT, risk of death after AIH-LT was superior compared with AC-LT (HR, 0.84; P = 0.004), worse compared with PBC-LT (HR, 1.38; P < 0.001) and similar compared with PSC-LT (P = 0.93). Autoimmune hepatitis (AIH) patients with living donor liver transplantation (LDLT) showed reduced survival compared with patients receiving donation after brain death (HR, 1.96; P < 0.001). In AIH-LT patients, overall survival is inferior to PBC-LT and PSC-LT. The high risk of death after AIH-LT is caused mainly by early fatal infections, including fungal infections. Patients with LDLT for AIH show reduced survival.
AB - The aim of this study was to analyze longterm patient and graft survival after liver transplantation for autoimmune hepatitis (AIH-LT) from the prospective multicenter European Liver Transplant Registry. Patient and liver graft survival between 1998 and 2017 were analyzed. Patients after AIH-LT (n = 2515) were compared with patients receiving LT for primary biliary cholangitis (PBC-LT; n = 3733), primary sclerosing cholangitis (PSC-LT; n = 5155), and alcohol-related cirrhosis (AC-LT; n = 19,567). After AIH-LT, patient survival was 79.4%, 70.8%, and 60.3% and graft survival was 73.2%, 63.4%, and 50.9% after 5, 10, and 15 years of follow-up. Overall patient survival was similar to patients after AC-LT (P = 0.44), but worse than after PBC-LT (hazard ratio [HR], 1.48; P < 0.001) and PSC-LT (HR, 1.19; P = 0.002). AIH-LT patients were at increased risk for death (HR, 1.37-1.84; P < 0.001) and graft loss (HR, 1.35-1.80; P < 0.001) from infections compared with all other groups and had a particularly increased risk for lethal fungal infections (HR, 3.38-4.20; P ≤ 0.004). Excluding patients who died within 90 days after LT, risk of death after AIH-LT was superior compared with AC-LT (HR, 0.84; P = 0.004), worse compared with PBC-LT (HR, 1.38; P < 0.001) and similar compared with PSC-LT (P = 0.93). Autoimmune hepatitis (AIH) patients with living donor liver transplantation (LDLT) showed reduced survival compared with patients receiving donation after brain death (HR, 1.96; P < 0.001). In AIH-LT patients, overall survival is inferior to PBC-LT and PSC-LT. The high risk of death after AIH-LT is caused mainly by early fatal infections, including fungal infections. Patients with LDLT for AIH show reduced survival.
U2 - 10.1002/lt.25739
DO - 10.1002/lt.25739
M3 - SCORING: Journal article
C2 - 32112516
VL - 26
SP - 866
EP - 877
JO - LIVER TRANSPLANT
JF - LIVER TRANSPLANT
SN - 1527-6465
IS - 7
ER -
