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Gender and ethnic differences in the post-liver transplant outcomes of patients with autoimmune hepatitis with acute liver failure at initial presentation: a case-control study.

Thuluvath PJ, Wagennar RR, Verma S - Arch Med Sci (2015)

Bottom Line: African American with AIH showed a trend for lower 5-year survival compared to Caucasians (55% vs. 80%, p = NS).Women had a better outcome, especially in those with non-AIH (p = 0.002).Women with non-AIH-related ALF have better survival than their male counterparts.

View Article: PubMed Central - PubMed

Affiliation: Institute for Digestive and Liver Diseases, Mercy Medical Center, Baltimore, USA.

ABSTRACT

Introduction: Autoimmune hepatitis (AIH) may initially present as acute liver failure (ALF). The outcome of liver transplantation (LT) in patients with AIH and ALF is not very well defined. We determined the outcome of LT in UNOS (United Network for Organ Sharing) status 1 adult patients with and without AIH using post-MELD (Model for End-Stage Liver Disease) UNOS data.

Material and methods: For each AIH patient, 3 patients with non-AIH, matched for age ±5 years and donor risk index (DRI) ±5 years, were identified; 200 patients (50 AIH, 150 non-AIH) were found eligible for the study.

Results: Patients with AIH were more likely to be female (p = 0.003), non-Caucasian (p = 0.009), have higher bilirubin (p = 0.003), longer waiting time (p = 0.01), and lower creatinine (p = 0.019). African American patients with AIH were younger (p = 0.003), had lower bilirubin (p = 0.037), and were more likely to have had a prior LT compared to Caucasians (p = 0.02). Kaplan-Meier analysis showed that 5-year post-LT survival was similar in those with and without AIH (p = 0.3). African American with AIH showed a trend for lower 5-year survival compared to Caucasians (55% vs. 80%, p = NS). Women had a better outcome, especially in those with non-AIH (p = 0.002).

Conclusions: Patients with AIH transplanted as status 1 have similar outcomes to those without AIH. Women with non-AIH-related ALF have better survival than their male counterparts.

No MeSH data available.


Related in: MedlinePlus

A – Kaplan-Meier survival curves in UNOS status 1 patients (overall) stratified by gender (male vs. female; log rank χ2 = 9.43, p = 0.002); B – Kaplan-Meier survival curves of UNOS status 1 patients with AIH stratified by gender (male vs. female; log rank χ2 = 0.18, p = 0.67); C – Kaplan-Meier survival curves of UNOS status 1 patients without AIH, stratified by gender (male vs. female; log rank χ2 = 8.18, p = 0.004)
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Figure 0003: A – Kaplan-Meier survival curves in UNOS status 1 patients (overall) stratified by gender (male vs. female; log rank χ2 = 9.43, p = 0.002); B – Kaplan-Meier survival curves of UNOS status 1 patients with AIH stratified by gender (male vs. female; log rank χ2 = 0.18, p = 0.67); C – Kaplan-Meier survival curves of UNOS status 1 patients without AIH, stratified by gender (male vs. female; log rank χ2 = 8.18, p = 0.004)

Mentions: The 5-year survival was similar in those with and without AIH (Figure 1, p = 0.29). The survival was similar in AA and Caucasians (Figure 2 A), but there was a lower survival in AA with AIH compared to Caucasians (65% vs. 80%), though the difference was not statistically significant (Figure 2 B). Overall, women had a better outcome (Figure 3 A, p = 0.002). When stratified by disease, there were no gender differences in those with AIH (Figure 3 B, p = 0.67), but women with non-AIH had a significantly better survival compared to men (Figure 3 C, p = 0.004).


Gender and ethnic differences in the post-liver transplant outcomes of patients with autoimmune hepatitis with acute liver failure at initial presentation: a case-control study.

Thuluvath PJ, Wagennar RR, Verma S - Arch Med Sci (2015)

A – Kaplan-Meier survival curves in UNOS status 1 patients (overall) stratified by gender (male vs. female; log rank χ2 = 9.43, p = 0.002); B – Kaplan-Meier survival curves of UNOS status 1 patients with AIH stratified by gender (male vs. female; log rank χ2 = 0.18, p = 0.67); C – Kaplan-Meier survival curves of UNOS status 1 patients without AIH, stratified by gender (male vs. female; log rank χ2 = 8.18, p = 0.004)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697044&req=5

Figure 0003: A – Kaplan-Meier survival curves in UNOS status 1 patients (overall) stratified by gender (male vs. female; log rank χ2 = 9.43, p = 0.002); B – Kaplan-Meier survival curves of UNOS status 1 patients with AIH stratified by gender (male vs. female; log rank χ2 = 0.18, p = 0.67); C – Kaplan-Meier survival curves of UNOS status 1 patients without AIH, stratified by gender (male vs. female; log rank χ2 = 8.18, p = 0.004)
Mentions: The 5-year survival was similar in those with and without AIH (Figure 1, p = 0.29). The survival was similar in AA and Caucasians (Figure 2 A), but there was a lower survival in AA with AIH compared to Caucasians (65% vs. 80%), though the difference was not statistically significant (Figure 2 B). Overall, women had a better outcome (Figure 3 A, p = 0.002). When stratified by disease, there were no gender differences in those with AIH (Figure 3 B, p = 0.67), but women with non-AIH had a significantly better survival compared to men (Figure 3 C, p = 0.004).

Bottom Line: African American with AIH showed a trend for lower 5-year survival compared to Caucasians (55% vs. 80%, p = NS).Women had a better outcome, especially in those with non-AIH (p = 0.002).Women with non-AIH-related ALF have better survival than their male counterparts.

View Article: PubMed Central - PubMed

Affiliation: Institute for Digestive and Liver Diseases, Mercy Medical Center, Baltimore, USA.

ABSTRACT

Introduction: Autoimmune hepatitis (AIH) may initially present as acute liver failure (ALF). The outcome of liver transplantation (LT) in patients with AIH and ALF is not very well defined. We determined the outcome of LT in UNOS (United Network for Organ Sharing) status 1 adult patients with and without AIH using post-MELD (Model for End-Stage Liver Disease) UNOS data.

Material and methods: For each AIH patient, 3 patients with non-AIH, matched for age ±5 years and donor risk index (DRI) ±5 years, were identified; 200 patients (50 AIH, 150 non-AIH) were found eligible for the study.

Results: Patients with AIH were more likely to be female (p = 0.003), non-Caucasian (p = 0.009), have higher bilirubin (p = 0.003), longer waiting time (p = 0.01), and lower creatinine (p = 0.019). African American patients with AIH were younger (p = 0.003), had lower bilirubin (p = 0.037), and were more likely to have had a prior LT compared to Caucasians (p = 0.02). Kaplan-Meier analysis showed that 5-year post-LT survival was similar in those with and without AIH (p = 0.3). African American with AIH showed a trend for lower 5-year survival compared to Caucasians (55% vs. 80%, p = NS). Women had a better outcome, especially in those with non-AIH (p = 0.002).

Conclusions: Patients with AIH transplanted as status 1 have similar outcomes to those without AIH. Women with non-AIH-related ALF have better survival than their male counterparts.

No MeSH data available.


Related in: MedlinePlus