The Clinical Paired Analysis Of Different Prognosis For Liver Transplantation Between Autoimmune Liver Disease And Viral Hepatitis Cirrhosis

Objective: Investigate the different prognosis of patients with autoimmune liver disease(AILD)and patients with viral hepatitis cirrhosis after undergoing liver transplantation(LT)in organ transplantation center of the First Affiliated Hospital of China Medical University.Method: All clinical data of AILD and viral hepatitis cirrhosis liver transplantation cases from January 2002 to January 2017 in the First Affiliated Hospital of China Medical University were collected and analyzed retrospectively.First,AILD cases were selected according to inclusion and exclusion criteria.Inclusion criteria :(1)AILD was diagnosed clearly with corresponding pathological support.(2)follow-up data after liver transplantation were improved.Exclusion criteria :(1)AILD with viral hepatitis or liver cancer.(2)the clinical data of cases are not perfect.During the study,there were 27 cases of AILD,2 cases of concurrent liver cancer were excluded,and the remaining 25 cases were studied.AILD cases were 1:2 matched with viral hepatitis cirrhosis.Patients with viral hepatitis cirrhosis with similar MELD score and age within two years(the difference between MELD score weighted 0.7 and age difference weighted 0.3 to choose the minimum)were selected,but cases for viral hepatitis cirrhosis combined with AILD or liver cancer,as well as cases with incomplete clinical data were excluded.Fifty cases of viral hepatitis cirrhosis were selected as control group.Preoperative indicators were collected: gender,age,Child-Pugh grading,MELD score.Intraoperative indicators:surgical mode,warm ischemia time,cold ischemia time,duration of surgery,duration of hepat-free phase,blood transfusion.Postoperative parameters: length of hospitalization,acute kidney injury,infection,acute rejection,vascular complications,biliary complications,post transplantation diabetes mellitus(PTDM),AILD recurrence,and survival time.After summarizing the data,SPSS 23 software was used for statistical analysis.Result: Preoperative gender ratio of AILD group and viral hepatitis group was different(P<0.001),and female patients had higher incidence in AILD,accounting for 80%,while male patients had higher incidence in viral hepatitis group,accounting for 82%.There were no statistical differences in age,Child-Pugh grading and MELD score.The transplantation was performed by the same transplantation team at the same time.Intraoperative indicators: surgical method,warm ischemia time,cold ischemia time,operation time,hepat-free period time,and blood transfusion volume showed no significant difference between the two groups.In terms of postoperative complications,the incidence of postoperative acute rejection in AILD group was higher than that in patients with viral hepatitis cirrhosis(48% vs 20%,P=0.012),and the diagnosis of acute rejection was clinical diagnosis without liver biopsy.The rate of severe acute renal injury was lower in AILD group than in viral hepatitis cirrhosis group(0% vs.16%,P=0.034).In terms of length of hospital stay,infection,vascular complications,biliary complications,and post-transplant diabetes,there was no significant difference between the two groups.In long-term follow-up,Kaplan-Meier survival curve was used to calculate the cumulative survival rate.The postoperative survival rates of 1,3 and 5 years in AILD group were 91.7%,87.3% and 87.3%.The 1-,3-,and 5-year survival rates of patients with viral hepatitis cirrhosis were 88.0%,88.0%,88.0%.There was no significant difference in the overall cumulative survival rate between the two groups(P=0.389).Seven indexes,including whether AILD or not,dialysis treatment of severe acute renal injury,infection,acute rejection,biliary complications,vascular complications,diabetes after transplantation were choosed in Cox model for stepwise regression,found that require dialysis treatment of severe acute renal function injury(RR:7.4,95% CI: 1.5-36.9)and biliary complications(RR: 7.5,95% CI: 1.9-30.3)were independent factors affecting the prognosis.Conclusion: There was no significant difference in the overall prognosis between patients with autoimmune liver disease and patients with viral hepatitis cirrhosis after liver transplantation.The incidence of clinical diagnosis of acute rejection after liver transplantation in patients with autoimmune liver disease was higher than that in patients with viral hepatitis cirrhosis after liver transplantation(48% vs 20%,P=0.012),and the incidence of severe renal function injury requiring dialysis treatment was significantly lower than that in patients with viral hepatitis cirrhosis after liver transplantation(0% vs16%,P=0.034).Severe acute renal injury requiring dialysis(RR: 7.4,95% CI: 1.5-36.9) and biliary complications(RR: 7.5,95% CI: 1.9-30.3)were independent risk factors for prognosis among postoperative complications.