| Background: Autoimmune hepatitis(AIH)is an inflammatory disease of the liver whose pathogenesis is not yet clear.It is usually characterized by elevated serum transaminase and immunoglobulin G levels,positive multiple autoantibodies,and detrital necrosis in the portal area[1].The current standard treatment for AIH is usually glucocorticoid alone or in combination with azathioprine,but a small number of AIH patients are not sensitive to medical treatment.Liver transplantation is the ultimate effective treatment for endstage AIH patients who are ineffective through medical immunotherapy and have stubborn liver-related syndromes.Due to the disorder of the autoimmune system of AIH patients,the incidence of rejection and recurrence after liver transplantation in AIH patients is relatively high,and even affects the prognosis of liver transplantation.Therefore,compared with liver transplants due to other diseases,the immunosuppression after AIH liver transplantation.The application of drugs and glucocorticoids is critical to the prognosis of patients.Based on the large number of people with viral hepatitis B liver cirrhosis in my country,the majority of liver transplant recipients in China are patients with end-stage viral hepatitis B liver disease and some patients with decompensated liver cirrhosis such as alcohol and drugs.For this type of patients,there are more complete immunosuppressive therapy programs.Because the pathogenesis of AIH patients is different from that of other patients with decompensated liver cirrhosis,the postoperative treatment and prognosis are still inconclusive.This article retrospectively analyzes perioperative data of 62 recipients with AIH and non-AIH,postoperative immunosuppressant,hormone use and prognostic differences and influencing factors,and conduct a controlled study to find the specificity of the treatment plan,to analyze and summarize the clinical Features.At the same time,we will analyze the clinical efficacy of AIH patients undergoing liver transplantation,to enrich the clinical experience,and hope to provide a theoretical basis for improving the level of clinical diagnosis and treatment.Methods: Using retrospective cohort research method.According to the inclusion and exclusion criteria,the clinical data of 62 liver transplant recipients admitted to the Second Hospital of Dalian Medical University from January 2000 to October 2015 were collected,including 22 AIH recipients,4 males and 18 females.The average age is 52.4 years.40 non-AIH recipients,including 30 liver transplant recipients with liver cirrhosis after viral hepatitis B,6 liver transplant recipients with drug-induced liver damage,4 liver transplant recipients with alcoholic cirrhosis,31 males and 9 females.The average age of 52.8 years.22 AIH liver transplant recipients were set as AIH group,and 40 non-AIH liver transplant recipients were set as non-AIH group.Observation indicators:(1)Preoperative general clinical data;(2)Perioperative data;(3)Postoperative complications;(4)Postoperative immunosuppressant usage and dosage;(5)Survival.Follow-up is carried out through outpatient clinic and telephone.All recipients were followed up every 6 months to understand the survival of the patients.The follow-up time is up to November 2020;(6)Factors affecting prognosis.Normally distributed measurement data are represented by the mean plus or minus standard deviation,and independent sample t-tests are used for comparison between the two data groups;non-normally distributed measurement data use the median,25 quartiles and 75 quartiles.Mann-Whitney Test is used for the comparison between the two groups of data.The count data is represented by the number of cases(%).The chi-square test is used for the comparison between the groups.The correlation analysis of the two variables used Spearman correlation analysis.The Kaplan-Meier survival curve was drawn to analyze the cumulative survival rate.The single factor analysis of survival data used the Log-rank test.The inspection level a=0.05.P<0.05 indicates that the difference is statistically significant.Results: 1.Preoperative general clinical data: The difference in the gender ratio of the two groups of recipients was statistically significant(P<0.05),and the incidence of women in the AIH group was high;other baseline data such as transplant age,preoperative Child-Pugh classification,end-stage liver disease model(Model for end-stage liver disease,MELD)scores were not statistically different(P>0.05).2.Perioperative data: There was no statistically significant difference in the operation time,duration of anhepatic phase,cold ischemia time,warm ischemia time,intraoperative blood loss,intraoperative red blood cell transfusion,intraoperative plasma transfusion,intraoperative platelet transfusion,ICU stay time and hospitalization time between the two groups of recipients(P>0.05).3.Postoperative complications: there was no significant difference in postoperative acute rejection,lung infection,biliary complications,abnormal renal function,and posttransplant diabetes between the two groups of recipients(P>0.05).4.Postoperative use and dosage of immunosuppressive agents: the postoperative use of glucocorticoids in the AIH group was(68.21±28.19)months,and the postoperative use of glucocorticoids in the non-AIH group was(2.86±0.84)months,the difference was statistically significant Significance(P<0.05);there was no statistically significant difference in the average dose of glucocorticoids,the average dose of anti-rejection drugs and the duration between the two groups of recipients after surgery(P>0.05).5.Survival: The 1-year,3-year,and 5-year survival rates of the AIH group were 86.36%,86.36%,and 86.36%,and the median survival time was 103.8 months.The 1-year,3-year,and 5-year survival rates of the non-AIH group were 90%,90%,and 87.5%,and the median survival time was 174.5 months.There was no statistically significant difference in the above indicators between the two groups of recipients(P>0.05).6.Influencing factors of prognosis: The univariate analysis showed that MELD score,lung infection and biliary tract-related complications were three indicators that affected the prognosis of the recipient(all P<0.05).Conclusion: 1.Compared with non-AIH recipients,AIH recipients need longer hormone application time,but there is no significant difference in the average amount of hormones between them.2.There is no significant difference in the dose and duration of postoperative immunosuppressive drugs(tacrolimus,mycophenolate mofetil)between AIH recipients and non-AIH recipients;3.There is no significant difference in overall survival prognosis between AIH recipients and non-AIH recipients after liver transplantation;4.Preoperative MELD score,postoperative lung infection and biliary tract-related complications of liver transplant recipients are risk factors that affect the prognosis of liver transplantation;5.The higher the MELD score of the recipient before surgery,the worse the short-term survival after surgery,and the higher the risk of death.The lower the MELD score,the better the short-term prognosis after surgery.Biliary complications and lung infections can seriously affect the early postoperative period Survival rate of liver transplant recipients;6.Due to the abnormal immune system of AIH patients,hormones play a very important role in AIH recipients after liver transplantation.Too early hormone withdrawal may lead to AIH recurrence or rejection after liver transplantation. |
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