Outcome of liver transplantation for autoimmune hepatitis in South Africa
- 1 January 2022
- journal article
- Published by Heighten Science Publications Corporation in Annals of Clinical Gastroenterology and Hepatology
- Vol. 6 (1), 044-050
- https://doi.org/10.29328/journal.acgh.1001038
Abstract
Background: Liver Transplantation (LT) is the definitive treatment for Autoimmune Hepatitis (AIH) in patients with decompensated cirrhosis, liver failure and hepatocellular carcinoma. Outcomes of LT in AIH among black-Africans are not well-defined. We performed a single-center retrospective-review of adult LT patients. The study period was from 1st August 2004-31st August 2019. The primary aim was to document 1- & 5- year patient and graft survival. A secondary aim was to compare the survival of black-Africans to Caucasians. Data was analyzed using survival-analysis. Results: A total of 56 LT were performed for AIH. Sixty-seven percent (n = 38/56) had confirmed AIH on explant histology. Of these, the majority i.e., 79% (30/38) were female and 21% (8/38) were male. There were equal numbers of black-African 42% (n = 16/38) and Caucasian 42% (n = 16/38) patients. Rejection was four-times higher in black-Africans as compared to Caucasians. Forty-four percent (n = 17/38) had an acute rejection episode and 13% (5/38) had chronic rejection. Recurrence was found in four black-African females. Post-LT patient survival at 1- and 5- years was 86.5% and 80.7%, and graft survival was 94% and 70.8% respectively. The 5- year patient survival was insignificantly lower for black-Africans (73.9%) as compared to Caucasians (83.7%) (p - value 0.26, CI 6.3 - 12.2). Five-year graft survival was significantly lower among black-Africans (55%) as compared to Caucasians (84.8%) (p - value 0.003 CI 3.8 - 8.1) Conclusion: Black-Africans had a four-fold higher rate of rejection compared to Caucasians. Recurrent AIH was only found in patients of black ethnicity. Similar 1- & 5- year patient survival rates were observed between the two ethnicities. The 5-year graft survival among black-Africans was significantly lower than Caucasians.Keywords
This publication has 38 references indexed in Scilit:
- Meta-Analysis: The Relationship Between CTLA-4 +49 A/G Polymorphism and Primary Biliary Cirrhosis and Type I Autoimmune HepatitisImmunological Investigations, 2015
- Autoimmune liver disease, autoimmunity and liver transplantationJournal of Hepatology, 2014
- Liver transplantation and autoimmune liver diseasesLiver Transplantation, 2013
- Diagnosis and management of autoimmune hepatitisJournal of Hepatology, 2010
- Autoimmune HepatitisThe New England Journal of Medicine, 2006
- Genetic analysis of the HLA region of Japanese patients with type 1 autoimmune hepatitisJournal of Hepatology, 2005
- Factors affecting variability in distribution of tacrolimus in liver transplant recipientsBritish Journal of Clinical Pharmacology, 2004
- Effect of race on outcome of orthotopic liver transplantation: a cohort studyThe Lancet, 2002
- Gender-dependent racial difference in disposition of cyclosporine among healthy African American and white volunteersClinical Pharmacology & Therapeutics, 2000
- Racial disparities in renal transplant outcomesAmerican Journal of Kidney Diseases, 1999