Cargando…
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...
Autores principales: | , , , , , , , , , |
---|---|
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 |
_version_ | 1783706621892886528 |
---|---|
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. |
format | Online Article Text |
id | pubmed-8196096 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT mccabemarshall hladrmismatchandblackraceareassociatedwithrecurrentautoimmunehepatitisafterlivertransplantation AT rushnatalia hladrmismatchandblackraceareassociatedwithrecurrentautoimmunehepatitisafterlivertransplantation AT lammertcraig hladrmismatchandblackraceareassociatedwithrecurrentautoimmunehepatitisafterlivertransplantation AT patidarkavishr hladrmismatchandblackraceareassociatedwithrecurrentautoimmunehepatitisafterlivertransplantation AT nephewlauren hladrmismatchandblackraceareassociatedwithrecurrentautoimmunehepatitisafterlivertransplantation AT saxenaromil hladrmismatchandblackraceareassociatedwithrecurrentautoimmunehepatitisafterlivertransplantation AT ekserburcin hladrmismatchandblackraceareassociatedwithrecurrentautoimmunehepatitisafterlivertransplantation AT salvenjames hladrmismatchandblackraceareassociatedwithrecurrentautoimmunehepatitisafterlivertransplantation AT kubalchandrashekhar hladrmismatchandblackraceareassociatedwithrecurrentautoimmunehepatitisafterlivertransplantation AT ghabrilmarwan hladrmismatchandblackraceareassociatedwithrecurrentautoimmunehepatitisafterlivertransplantation |