872 AUTOIMMUNE HEPATITIS PATIENTS ARE LESS LIKELY TO RECEIVE LIVER TRANSPLANT THAN OTHER AUTOIMMUNE LIVER DISEASES, REGARDLESS OF FUNCTIONAL STATUS

2020 ◽  
Vol 158 (6) ◽  
pp. S-182
Author(s):  
Artin Galoosian ◽  
Courtney Hanlon ◽  
Robert J. Wong
Keyword(s):  
Liver Transplant ◽  
Autoimmune Hepatitis ◽  
Functional Status ◽  
Liver Diseases ◽  
Autoimmune Liver Diseases ◽  
To Receive

scholarly journals Clinical Significance of Autoantibodies to P53 Protein in Patients with Autoimmune Liver Diseases

2012 ◽  
Vol 26 (3) ◽  
pp. 125-129 ◽  
Author(s):  
Takashi Himoto ◽  
Hirohito Yoneyama ◽  
Kazutaka Kurokohchi ◽  
Michio Inukai ◽  
Hisashi Masugata ◽  
...  
Keyword(s):  
Primary Biliary Cirrhosis ◽  
Autoimmune Hepatitis ◽  
Clinical Significance ◽  
Conformational Changes ◽  
Clinical Relevance ◽  
Liver Diseases ◽  
P53 Protein ◽  
Biliary Cirrhosis ◽  
Autoimmune Liver Diseases ◽  
Circulating Autoantibodies

Mutations in thep53gene leading to conformational changes in the p53 protein have been well established in many human cancers. Conformational changes and/or cellular accumulation of the protein may induce an immune response, resulting in circulating autoantibodies to p53, which have been documented in several types of cancers. Although rarely associated with autoimmune disease, a few reports have documented titres of anti-p53 autoantibodies in patients with autoimmune hepatitis and primary biliary cirrhosis. The clinical relevance of circulating autoantibodies to p53, therefore, remains unclear. Accordingly, this study aimed to examine the prevalence and clinical relevance of anti-p53 autoantibodies in patients with selected autoimmune liver diseases.BACKGROUND: Autoantibodies to p53 (anti-p53) are rarely present in the sera of patients with autoimmune diseases or the sera of patients with malignancies.OBJECTIVE: To examine the prevalence of anti-p53 in patients with autoimmune liver disease including autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), AIH/PBC overlap syndrome (AIH/PBC OS) and primary sclerosing cholangitis (PSC), and to determine the clinical significance of anti-p53 in autoimmune liver diseases.METHODS: Forty patients with AIH, 41 patients with PBC, eight patients with AIH/PBC OS and five patients with PSC were enrolled. Anti-p53 and antibodies to double-stranded DNA (anti-ds-DNA) were analyzed using commercially available ELISA kits. Demographic, laboratory and histological data were compared between the AIH groups seropositive and seronegative for anti-p53.RESULTS: Six of 40 (15.0%) patients with AIH and four of eight (50.0%) patients with AIH/PBC OS were positive for anti-p53. One of 41 (2.4%) patients with PBC was also positive for anti-p53, but all five patients with PSC were negative, indicating a significantly higher prevalence of anti-p53 in patients with AIH or AIH/PBC OS compared with patients with PBC. None of the AIH patients positive for anti-p53 progressed to hepatic failure or relapsed after immunosuppressive treatment. Titres of anti-ds-DNA in patients with AIH and AIH/PBC OS significantly correlated with titres of anti-p53 (r=0.511; P=0.0213).CONCLUSION: The emergence of anti-p53 is likely to be useful for discriminating AIH or AIH/PBC OS from PBC and helpful for predicting favourable prognoses in patients with AIH. DNA damage may trigger the production of anti-p53 in patients with AIH or AIH/PBC OS.

Population-based study of autoimmune hepatitis and primary biliary cholangitis in Germany: rising prevalences based on ICD codes, yet deficits in medical treatment

2020 ◽  
Vol 58 (05) ◽  
pp. 431-438 ◽  
Author(s):  
Marcial Sebode ◽  
Angela Kloppenburg ◽  
Annette Aigner ◽  
Ansgar W. Lohse ◽  
Christoph Schramm ◽  
...  
Keyword(s):  
Autoimmune Hepatitis ◽  
Liver Diseases ◽  
Unmet Need ◽  
Real Life ◽  
Population Based ◽  
Medical Community ◽  
Primary Biliary Cholangitis ◽  
Autoimmune Liver Diseases ◽  
Background Population ◽  
Icd Codes

Abstract Background Population-based data on the prevalence of and real-life treatment for the autoimmune liver diseases (AILD), primary biliary cholangitis (PBC) and autoimmune hepatitis (AIH), are scarce, and such knowledge may help to improve patient care. Methods Data of 8.1 million individuals having health insurance with the “Techniker Krankenkasse,” the largest German health insurer, were analyzed with regard to the prevalence of and prescribed medication for AILD in Germany from 2011 until 2014. Patients with viral hepatitis B infection (HBV) and alcoholic liver cirrhosis (ALC) served as control groups. Case definition was based on ICD codes. Results The prevalences of PBC and AIH were 36.9/100 000 inhabitants (95 % CI: 35.6–38.2) and 23.0/100 000 inhabitants (95 % CI: 22.0–24.0) in 2014, respectively. The prevalences of AILD increased from 2011 to 2014 (for PBC by 31 % and for AIH by 29 %), with the largest increase for male patients with PBC. In contrast, the prevalence of HBV declined while that of ALC remained stable. The analysis of prescribed real-life treatment revealed considerable deviations from standard treatment recommendations. Specifically, in older patients with PBC or AIH, undertreatment was common. Conclusion The prevalence of PBC and AIH based on ICD codes is increasing in Germany. The analysis of real-life treatment in this large and population-based cohort points to the unmet need to improve the implementation of treatment guidelines for autoimmune liver diseases in the broader medical community.

Increased Posttransplant Mortality for Autoimmune Hepatitis Compared With Other Autoimmune Liver Diseases

2019 ◽  
Vol 54 (7) ◽  
pp. 648-654 ◽  
Author(s):  
Jennifer Y. Lee ◽  
Christopher J. Danford ◽  
Vilas R. Patwardhan ◽  
Alan Bonder
Keyword(s):  
Autoimmune Hepatitis ◽  
Liver Diseases ◽  
Autoimmune Liver Diseases

scholarly journals Waitlist Mortality and Posttransplant Outcomes in African Americans with Autoimmune Liver Diseases

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
John Paul Nsubuga ◽  
Daniela Goyes ◽  
Hirsh D. Trivedi ◽  
Esli Medina-Morales ◽  
Vilas Patwardhan ◽  
...  
Keyword(s):  
African Americans ◽  
Risk Analysis ◽  
Liver Transplant ◽  
Graft Survival ◽  
Liver Diseases ◽  
Cox Regression ◽  
Survival Rates ◽  
Competing Risk ◽  
Competing Risk Analysis ◽  
Autoimmune Liver Diseases

Background. Liver transplantation is indicated in end-stage liver disease due to autoimmune diseases. The liver allocation system can be affected by disparities such as decreased liver transplant referrals for racial minorities, especially African Americans that negatively impact the pre- and posttransplant outcomes. Aim. To determine differences in waitlist survival and posttransplant graft survival rates between African American and Caucasian patients with autoimmune liver diseases. Study. The United Network for Organ Sharing database was used to identify all patients with autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis who underwent liver transplant from 1988 to 2019. We compared waitlist survival and posttransplant graft survival between Caucasians and African Americans using Kaplan–Meier curves and Cox regression models. We also evaluated the cumulative incidence of death or delisting for deterioration and posttransplant incidence of death and retransplantation using competing risk analysis. Results. African Americans were more likely to be removed from the waitlist for death or clinical deterioration (subdistribution hazard ratio (SHR) 1.26, 95% CI 1–1.58, P = 0.046 ) using competing risk analysis. On multivariate Cox regression analysis, there was no difference in posttransplant graft survival among the two groups (hazard ratio (HR) 1.10, 95% CI 0.98–1.23, P = 0.081 ). Conclusions. Despite the current efforts to reduce racial disparities, we found that African Americans are more likely to die on the waitlist for liver transplant and are less likely to be transplanted, with no differences in graft survival rates. The persistence of healthcare disparities continues to negatively impact African Americans.

scholarly journals Management of Autoimmune Liver Diseases after Liver Transplantation

2021 ◽  
Vol 2 (2) ◽  
pp. 162-182
Author(s):  
Romelia Barba Bernal ◽  
Esli Medina-Morales ◽  
Daniela Goyes ◽  
Vilas Patwardhan ◽  
Alan Bonder
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Liver Diseases ◽  
Hepatitis A ◽  
Calcineurin Inhibitor ◽  
Liver Graft ◽  
Primary Biliary Cholangitis ◽  
Autoimmune Liver Diseases ◽  
Immune Mediated ◽  
Disease Modifying Agents

Autoimmune liver diseases are characterized by immune-mediated inflammation and eventual destruction of the hepatocytes and the biliary epithelial cells. They can progress to irreversible liver damage requiring liver transplantation. The post-liver transplant goals of treatment include improving the recipient’s survival, preventing liver graft-failure, and decreasing the recurrence of the disease. The keystone in post-liver transplant management for autoimmune liver diseases relies on identifying which would be the most appropriate immunosuppressive maintenance therapy. The combination of a steroid and a calcineurin inhibitor is the current immunosuppressive regimen of choice for autoimmune hepatitis. A gradual withdrawal of glucocorticoids is also recommended. On the other hand, ursodeoxycholic acid should be initiated soon after liver transplant to prevent recurrence and improve graft and patient survival in primary biliary cholangitis recipients. Unlike the previously mentioned autoimmune diseases, there are not immunosuppressive or disease-modifying agents available for patients with primary sclerosing cholangitis. However, colectomy and annual colonoscopy are key components during the post-liver transplant period.

Non-viral aspects

2018 ◽  
Vol 1 (2) ◽  
pp. 37-39
Author(s):  
Roongruedee Chaiteerakij
Keyword(s):  
Autoimmune Hepatitis ◽  
Liver Diseases ◽  
Sclerosing Cholangitis ◽  
Promising Result ◽  
Primary Biliary Cholangitis ◽  
Second Line Therapy ◽  
Thai Population ◽  
The Past ◽  
Line Therapy ◽  
New Treatment

Autoimmuneliver diseases, particularly autoimmune hepatitis and primary biliary cholangitis,are not uncommon among the Thai population. This article summarizes main findings of studies of autoimmune liver diseases published during the past year, which included natural history and long-termoutcomes of primary biliary cholangitis treatment, a promising result of the new treatment for primary sclerosing cholangitis and outcomes of a second-line therapy of autoimmune hepatitis.

scholarly journals Interest in Immunosuppression Withdrawal among Liver Transplant and Autoimmune Hepatitis Patients

2021 ◽  
Vol 12 (2) ◽  
pp. 147-154
Author(s):  
Eden Sharabi ◽  
Allison Carroll ◽  
Peter Cummings ◽  
Josh Levitsky
Keyword(s):  
Decision Making ◽  
Liver Transplant ◽  
Autoimmune Hepatitis ◽  
Immunological Tolerance ◽  
Side Effect Profile ◽  
Transplant Recipients ◽  
Single Center ◽  
Patient Reported ◽  
Liver Transplant Recipients ◽  
Mean Time

Immunosuppression withdrawal (ISW) is considered in liver transplant recipients (LTRs) and autoimmune hepatitis patients (AIHPs). Immunosuppressive therapy (IST) can be burdensome both financially and due to its side effect profile, making ISW an important intervention to consider. Data on patient interest in ISW would be helpful to providers in ISW decision-making. We conducted independent single-center surveys of LTR and AIHP attitudes on IST and withdrawal interest. Of 325 LTRs screened, 120 completed the survey (50% female, mean age 58 ± 14 years, mean time since transplant 8 ± 10.5 years and 79.5% Caucasian). Of 100 AIHPs screened, 45 completed the survey (77.8% female, mean age 54 ± 2 and 82.2% Caucasian). A higher percentage of AIHPs expressed concern with their IST and were interested in ISW compared with LTRs. However, over a third of LTRs were interested in ISW, particularly those with knowledge of this potential intervention. LTRs who discussed ISW with a physician were more likely to desire withdrawal (p = 0.02; OR = 2.781 (95% CI = 1.125, 6.872)). As patient interest in ISW is of growing interest, investigators should continue to assess patient-reported desires and outcomes and pursue strategies to achieve immunological tolerance.

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