Long-term corticosteroid use after liver transplantation for autoimmune hepatitis is safe and associated with a lower incidence of recurrent disease
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Patients transplanted for autoimmune hepatitis (AIH) are at risk of recurrent disease. Our current practice is to maintain long-term low dose corticosteroids with additional immunosuppressive agents. This study describes the implications on patients' outcomes, sepsis and osteoporosis. Methods We collected data on patients transplanted between Jan 1999-Oct 2014 in a single center who survived for more than 6 months. AIH recurrence was diagnosed by a combination of histology, raised IgG levels and exclusion of other aetiologies. Sepsis was defined as any infection that resulted in significant morbidity or mortality. Osteoporosis was defined as a bone densitometry T-score of <-2.0 or evidence of osteoporosis related fractures. Outcomes were assessed using Kaplan-Meier survival analysis methods. Results 73 AIH patients underwent liver transplantation with a median follow-up of 94 months (IQR 55-144). The cohort was mainly Caucasian (78%), female (79%), with type 1 AIH (90%) and a mean age of 43±15 years. Overall survival was 92%, 90%, 86% and 73%, and re-graft free survival was 86%, 81%, 78% and 64% at 1, 3, 5 and 10 years respectively. Five patients developed AIH recurrence, giving recurrence rates of 0%, 4%, 6% and 11% at 1, 3, 5 and 10 years respectively. Pneumonia was the most common infection but gastroenteritis and cholangitis were the most recurrent. Freedom from sepsis was 91%, 82%, 80% and 63%, and freedom from osteoporosis was 100%, 94%, 82% and 58% at 1, 3, 5 and 10 years respectively. Conclusion Long-term low dose corticosteroid in combination with other immunosuppressive agents seems to reduce AIH recurrence without jeopardising patient and graft survival. Sepsis and osteoporosis did not occur more often compared to the published literature on liver transplant recipients. This article is protected by copyright. All rights reserved.
|Early online date||23 Nov 2015|
|Publication status||Published - Jan 2016|