Adult and pediatric liver transplantation for autoimmune hepatitis

Heffron, Thomas G.; Smallwood, Gregory; Oakley, B.; Pillen, Todd; Welch, David; Connor, K.; Martínez, Enrique; Romero, René; Stieber, Andrei C.

doi:10.1016/s0041-1345(03)00457-3

Cited by 7 publications

(6 citation statements)

References 3 publications

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“…For the purpose of this study, patients to whom a second diagnosis of primary sclerosing cholangitis was given were excluded from the analysis, and this limited but did not exclude the effect of overlapping features with sclerosing cholangitis. Along the same line, a higher rate of ulcerative colitis development after LTX for AIH has been noted in pediatric patients versus adult patients, but short‐term survival was similar between the groups 31. Moreover, the outcome of the 89 pediatric patients with AIH reported here was similar to that of adult patients undergoing transplantation for AIH under the age of 50 years.…”

Section: Discussionsupporting

confidence: 77%

Primary liver transplantation for autoimmune hepatitis: A comparative analysis of the European Liver Transplant Registry

et al. 2010

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The principal aim of this study was to compare the probability of and potential risk factors for death and graft loss after primary adult and pediatric liver transplantation in patients undergoing transplantation for autoimmune hepatitis (AIH) to those in patients undergoing transplantation for primary biliary cirrhosis (PBC; used as the reference group) or alcoholic cirrhosis (used as an example of a nonautoimmune liver disease). The 5-year survival of patients undergoing transplantation for AIH (n ¼ 827) was 0.73 [95% confidence interval (CI) ¼ 0.67-0.77]. This was similar to that of patients undergoing transplantation for alcoholic cirrhosis (0.74, 95% CI ¼ 0.72-0.76, n ¼ 6424) but significantly worse than that of patients undergoing transplantation for PBC

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Section: Discussionsupporting

confidence: 77%

Primary liver transplantation for autoimmune hepatitis: A comparative analysis of the European Liver Transplant Registry

et al. 2010

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“…Despite a greater degree of immunosuppression required in the posttransplant period, outcomes are similar to the overall transplanted population in terms of infectious or metabolic complications. The risk of late rejection is higher for those who receive LT for AIH, but this does not result in increased chronic rejection, steroid resistant rejection, or the need for retransplantation, which differs from adults . Pediatric patients transplanted for AIH may be at greater risk of developing ulcerative colitis after LT than adult patients .…”

Section: Indications For Liver Transplantationmentioning

confidence: 99%

Evaluation of the pediatric patient for liver transplantation: 2014 practice guideline by the american association for the study of liver diseases, american society of transplantation and the north american society for pediatric gastroenterology, hepatolo

et al. 2014

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“…Ninety-two samples from 14 patients were analyzed (average 6.5 samples per patient; range [4][5][6][7][8][9][10][11][12]. In four patients inappropriately low 6-TG levels (<50 pmol per 8 · 10 8 RBC) were consistently obtained despite AZA dose escalation ( Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Seven patients were diagnosed with RAIH and the other seven had post-transplant IMH. Their mean age was 12.8 yr (range [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]; nine were females. The inclusion criteria were: age <21 yr, IMH/RAIH diagnosed by liver biopsy, abnormal liver function tests, and the presence of at least one autoimmune marker (antinuclear antibodies, anti-smooth muscle antibodies, liver-kidney microsome antibodies) at the time of diagnosis.…”

Section: Methodsmentioning

confidence: 99%

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Utility of azathioprine metabolite measurements in post‐transplant recurrent autoimmune and immune‐mediated hepatitis

Rumbo

Shneider

Emre

2004

Pediatric Transplantation

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Patients with post-transplant immune-mediated hepatitis (IMH) and recurrent autoimmune hepatitis (RAIH) have a poor outcome and a higher need for retransplantation. Azathioprine (AZA) is used as adjunctive immunosuppression after transplantation; optimizing its dose may be a key point in preserving graft function. Complications of high AZA dosing make dose escalation potentially problematic. Our aim was to correlate AZA metabolite levels with therapeutic effects, toxicity, and adherence to medication in children with IMH and RAIH. Charts of 14 patients were retrospectively reviewed. The post-transplant diagnosis was based on liver biopsy and autoimmune markers. AZA was prescribed after establishing the post-transplant diagnosis. AZA was started at 1.1 (1.0-1.8) mg/kg/day. Routine biochemical studies, tacrolimus levels, 6-thioguanine (6-TG) and 6-methylmercaptopurine levels were assessed every 8 wk. AZA dose was routinely adjusted to achieve 6-TG levels between 235 and 450 pmol per 8 x 10(8) RBC. A total of 92 samples from 14 patients were reviewed. Four patients were excluded because of non-adherence. AZA dose was increased by 245% resulting in eight of 10 patients in the target range; no hepatic or bone marrow toxicity was observed. ALT levels and steroid requirements were significantly reduced (p < 0.05). The AZA dose required to achieve target 6-TG levels was significantly greater in children <10 yr. AZA metabolite testing in children post-liver transplant is useful in assessing adherence to medication and it is potentially helpful in optimizing medication dosing. In younger children the AZA dose requirements were two to four times higher than previously reported standard doses.

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Adult and pediatric liver transplantation for autoimmune hepatitis

Cited by 7 publications

References 3 publications

Primary liver transplantation for autoimmune hepatitis: A comparative analysis of the European Liver Transplant Registry

Primary liver transplantation for autoimmune hepatitis: A comparative analysis of the European Liver Transplant Registry

Evaluation of the pediatric patient for liver transplantation: 2014 practice guideline by the american association for the study of liver diseases, american society of transplantation and the north american society for pediatric gastroenterology, hepatolo

Utility of azathioprine metabolite measurements in post‐transplant recurrent autoimmune and immune‐mediated hepatitis

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