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HLA-DR Mismatch and Black Race Are Associated With Recurrent Autoimmune Hepatitis After Liver Transplantation

The predictors of recurrent autoimmune hepatitis (R-AIH) after liver transplantation (LT) are heterogeneous with limited data to guide immunosuppression, with little data on impact of race. AIMS. To describe the incidence, predictors, and outcomes of R-AIH. METHODS. We studied patients undergoing LT...

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Autores principales: McCabe, Marshall, Rush, Natalia, Lammert, Craig, Patidar, Kavish R., Nephew, Lauren, Saxena, Romil, Ekser, Burcin, Salven, James, Kubal, Chandrashekhar, Ghabril, Marwan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8196096/
https://www.ncbi.nlm.nih.gov/pubmed/34131586
http://dx.doi.org/10.1097/TXD.0000000000001160
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author McCabe, Marshall
Rush, Natalia
Lammert, Craig
Patidar, Kavish R.
Nephew, Lauren
Saxena, Romil
Ekser, Burcin
Salven, James
Kubal, Chandrashekhar
Ghabril, Marwan
author_facet McCabe, Marshall
Rush, Natalia
Lammert, Craig
Patidar, Kavish R.
Nephew, Lauren
Saxena, Romil
Ekser, Burcin
Salven, James
Kubal, Chandrashekhar
Ghabril, Marwan
author_sort McCabe, Marshall
collection PubMed
description The predictors of recurrent autoimmune hepatitis (R-AIH) after liver transplantation (LT) are heterogeneous with limited data to guide immunosuppression, with little data on impact of race. AIMS. To describe the incidence, predictors, and outcomes of R-AIH. METHODS. We studied patients undergoing LT for AIH during 2000–2017 at our center. Liver biopsies were performed for clinical indications. R-AIH was defined using clinical and histologic criteria. RESULTS. Among 75 patients undergoing LT for AIH (mean age 45 ± 16, 65% female individuals, 19% Black), 71 (95%) received antithymocyte globulin induction with tacrolimus-based immunosuppression. R-AIH developed in 20 (27%) patients at a median interval of 313 d (interquartile range, 155–1205). R-AIH was associated with level 2 HLA-DR mismatch (hazard ratio, 3.6; (95% confidence interval, 1.3-9.9; P = 0.01) and Black race (hazard ratio, 4.5; 95% confidence interval, 1.8-11.8; P = 0.002)] in the multivariable analysis. R-AIH developed in 62% of patients with level 2 HLA-DR mismatch on single-agent immunosuppression but in <20% of patients with no or 1 HLA-DR mismatch regardless of maintenance immunosuppression. R-AIH developed in 8 (57%) of 14 Black patients (71% on single-agent and 43% on dual-agent maintenance immunosuppression). Patient and graft survival were not impacted by R-AIH over a median follow-up of 8.3 y (interquartile range, 3–12). CONCLUSIONS. High-level HLA-DR mismatch and Black recipient race are associated with an increased risk of R-AIH. Immunosuppression did not predict R-AIH, but higher rates of disease recurrence with single-agent maintenance immunosuppression with these risk factors were observed and may guide maintenance immunosuppression in LT for AIH.
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spelling pubmed-81960962021-06-14 HLA-DR Mismatch and Black Race Are Associated With Recurrent Autoimmune Hepatitis After Liver Transplantation McCabe, Marshall Rush, Natalia Lammert, Craig Patidar, Kavish R. Nephew, Lauren Saxena, Romil Ekser, Burcin Salven, James Kubal, Chandrashekhar Ghabril, Marwan Transplant Direct Liver Transplantation The predictors of recurrent autoimmune hepatitis (R-AIH) after liver transplantation (LT) are heterogeneous with limited data to guide immunosuppression, with little data on impact of race. AIMS. To describe the incidence, predictors, and outcomes of R-AIH. METHODS. We studied patients undergoing LT for AIH during 2000–2017 at our center. Liver biopsies were performed for clinical indications. R-AIH was defined using clinical and histologic criteria. RESULTS. Among 75 patients undergoing LT for AIH (mean age 45 ± 16, 65% female individuals, 19% Black), 71 (95%) received antithymocyte globulin induction with tacrolimus-based immunosuppression. R-AIH developed in 20 (27%) patients at a median interval of 313 d (interquartile range, 155–1205). R-AIH was associated with level 2 HLA-DR mismatch (hazard ratio, 3.6; (95% confidence interval, 1.3-9.9; P = 0.01) and Black race (hazard ratio, 4.5; 95% confidence interval, 1.8-11.8; P = 0.002)] in the multivariable analysis. R-AIH developed in 62% of patients with level 2 HLA-DR mismatch on single-agent immunosuppression but in <20% of patients with no or 1 HLA-DR mismatch regardless of maintenance immunosuppression. R-AIH developed in 8 (57%) of 14 Black patients (71% on single-agent and 43% on dual-agent maintenance immunosuppression). Patient and graft survival were not impacted by R-AIH over a median follow-up of 8.3 y (interquartile range, 3–12). CONCLUSIONS. High-level HLA-DR mismatch and Black recipient race are associated with an increased risk of R-AIH. Immunosuppression did not predict R-AIH, but higher rates of disease recurrence with single-agent maintenance immunosuppression with these risk factors were observed and may guide maintenance immunosuppression in LT for AIH. Lippincott Williams & Wilkins 2021-06-10 /pmc/articles/PMC8196096/ /pubmed/34131586 http://dx.doi.org/10.1097/TXD.0000000000001160 Text en Copyright © 2021 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Liver Transplantation
McCabe, Marshall
Rush, Natalia
Lammert, Craig
Patidar, Kavish R.
Nephew, Lauren
Saxena, Romil
Ekser, Burcin
Salven, James
Kubal, Chandrashekhar
Ghabril, Marwan
HLA-DR Mismatch and Black Race Are Associated With Recurrent Autoimmune Hepatitis After Liver Transplantation
title HLA-DR Mismatch and Black Race Are Associated With Recurrent Autoimmune Hepatitis After Liver Transplantation
title_full HLA-DR Mismatch and Black Race Are Associated With Recurrent Autoimmune Hepatitis After Liver Transplantation
title_fullStr HLA-DR Mismatch and Black Race Are Associated With Recurrent Autoimmune Hepatitis After Liver Transplantation
title_full_unstemmed HLA-DR Mismatch and Black Race Are Associated With Recurrent Autoimmune Hepatitis After Liver Transplantation
title_short HLA-DR Mismatch and Black Race Are Associated With Recurrent Autoimmune Hepatitis After Liver Transplantation
title_sort hla-dr mismatch and black race are associated with recurrent autoimmune hepatitis after liver transplantation
topic Liver Transplantation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8196096/
https://www.ncbi.nlm.nih.gov/pubmed/34131586
http://dx.doi.org/10.1097/TXD.0000000000001160
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