Su1024 Fully Covered Self-Expandable Metallic Stents in Anastomotic Biliary Stenosis After Liver Transplantation: The Experience of a High Volume Transplantation Center
2015; Elsevier BV; Volume: 148; Issue: 4 Linguagem: Inglês
10.1016/s0016-5085(15)33554-x
ISSN1528-0012
AutoresF. D’Aversa, Anna Baldan, Silvia Pecere, Roberto Agazzi, Antonio Gasbarrini, M. Colledan, P. Ravelli, S. Fagiuoli,
Tópico(s)Pediatric Hepatobiliary Diseases and Treatments
ResumoBackgrounds/aims De-novo autoimmune hepatitis (AIH) after liver transplantation (LT) is rising.Yet there is scarcity of data on the characteristics and the long-term outcomes of this condition.The aim of this study is to investigate the clinical characteristics and long-term outcomes of patients with de novo AIH following LT.Methods Using transplant liver biopsy database, we identified all patients with de-novo AIH following LT at our institution between 2008 and 2013.Patients with hepatitis C virus infection were excluded.The diagnosis of de-novo AIH was made according to the classical and simplified criteria defined by the International Autoimmune Hepatitis Group.Clinical information was gathered from electronic medical records.H&E stained sections and histochemical stains from the liver biopsies revealed findings compatible with AIH.Results A total of nineteen patients with de-novo AIH were identified (58% female, median age of 46 years), with mean international autoimmune hepatitis score of 12.1.Underlying liver disease were primary sclerosing cholangitis (n=4), primary biliary cirrhosis (n=3), biliary atresia (n=3), drug induced liver failure (n=2), alcoholic hepatitis (n=2) and others (n=5).The interval period from the LT to diagnosis of de-novo AIH was 19.6 months (1.6-197.8),during which 11 (58%) patients developed at least one episode of acute cellular rejection prior to the diagnosis of de-novo AIH.All patients were successfully treated with corticosteroids and incremental dose in immunosuppression.All showed complete biochemical response to treatment but 9 (47.4%)patients relapsed upon tapering down corticosteroids.Patients were followed over 6.7 year (1.5-17) years post-LT.Eight (42%) patients progressed to cirrhosis of whom 3 (15%) patients expired and 2 (10%) required second LT due to complications of end stage liver disease.Conclusion The present study shows the long term clinical outcomes of the patients with de-novo AIH post-LT.Although most patients exhibit a good initial response to medical therapy, de-novo AIH post-LT is likely to recur and progress to liver cirrhosis.Therefore, we should consider denovo AIH in patients who show abnormal liver tests or graft dysfunction after LT.
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