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Article Dans Une Revue Liver International Année : 2023

Liver transplantation for autoimmune hepatitis: Pre‐transplant does not predict the early post‐transplant outcome

1 Hôpital Edouard Herriot [CHU - HCL]
2 UCBL - Université Claude Bernard Lyon 1
3 Hôpital de la Croix-Rousse [CHU - HCL]
4 Hôpital Beaujon [AP-HP]
5 CRI (UMR_S_1149 / ERL_8252 / U1149) - Centre de recherche sur l'Inflammation
6 Physiopathologie et traitement des maladies du foie
7 CHB - Centre Hépato-Biliaire [Hôpital Paul Brousse]
8 DHU Hepatinov [Villejuif]
9 CHU Estaing [Clermont-Ferrand]
10 IP - Institut Pascal
11 Hôpital Côte de Nacre [CHU Caen]
12 Hôpital Trousseau
13 Hôpital de Hautepierre [Strasbourg]
14 CRSA - Centre de Recherche Saint-Antoine
15 FILFOIE - Centre de référence des Maladies Vasculaires du Foie [Paris]
16 CHU Saint-Antoine [AP-HP]
17 CHU Pitié-Salpêtrière [AP-HP]
18 Hôpital Claude Huriez [Lille]
19 CHU Henri Mondor [Créteil]
20 CHU Nice - Centre Hospitalier Universitaire de Nice
21 UNSA - Université de Nice Sophia-Antipolis
22 TIMONE - Hôpital de la Timone [CHU - APHM]
23 IAB - Institute for Advanced Biosciences / Institut pour l'Avancée des Biosciences (Grenoble)
24 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
25 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
26 Département de Néphrologie et Transplantation d'organes [CHU Toulouse]
27 Service d'Hépato-Gastro-Entérologie (CHU de Dijon)
28 EPICAD - Epidémiologie et recherche clinique en oncologie digestive (CTM UMR 1231)
29 Hôpital Haut-Lévêque [CHU Bordeaux]
30 CHRU Montpellier - Hôpital Saint Eloi
31 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
32 HCL - Hospices Civils de Lyon
Armand Abergel
Christophe Duvoux
Sylvie Radenne

Résumé

Background and aims: Autoimmune hepatitis (AIH) is a rare indication (<5%) for liver transplantation (LT). The aim of this study was to describe the early outcome after LT for AIH. Methods: A multicenter retrospective nationwide study including all patients aged ≥16 transplanted for AIH in France was conducted. Occurrences of biliary and vascular complications, rejection, sepsis, retransplantation and death were collected during the first year after LT. Results: A total of 344 patients (78.8% of women, 17.0% of (sub)fulminant hepatitis and 19.2% of chronic liver diseases transplanted in the context of acute-on-chronic liver failure [ACLF]) were included, with a median age at LT of 43.6 years. Acute rejection, sepsis, biliary and vascular complications occurred in respectively 23.5%, 44.2%, 25.3% and 17.4% of patients during the first year after LT. One-year graft and patient survivals were 84.3% and 88.0% respectively. The main cause of early death was sepsis. Pre-LT immunosuppression was not associated with an increased risk for early infections or surgical complications. Significant risk factors for septic events were LT in the context of (sub)fulminant hepatitis or ACLF, acute kidney injury at the time of LT (AKI) and occurrence of biliary complications after LT. AKI was the only independent factor associated with graft (HR = 2.5; 95% CI: 1.1-5.4; p = .02) and patient survivals (HR = 2.6; 95% CI: 1.0-6.5; p = .04). Conclusion: Early prognosis is good after LT for AIH and is not impacted by pre-LT immunosuppression but by the presence of AKI at the time of LT.
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hal-04166795 , version 1 (29-05-2024)

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Yasmina Chouik, Claire Francoz, Eleonora de Martin, Olivier Guillaud, Armand Abergel, et al.. Liver transplantation for autoimmune hepatitis: Pre‐transplant does not predict the early post‐transplant outcome. Liver International, 2023, 43 (4), pp.906-916. ⟨10.1111/liv.15500⟩. ⟨hal-04166795⟩
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