PMID- 32034878
OWN - NLM
STAT- MEDLINE
DCOM- 20210318
LR  - 20210323
IS  - 1527-6473 (Electronic)
IS  - 1527-6465 (Linking)
VI  - 26
IP  - 6
DP  - 2020 Jun
TI  - Role of Autoimmunity in Patients Transplanted for Acute Liver Failure of Unknown 
      Origin: A Clinical and Graft Biopsy Analysis.
PG  - 764-773
LID - 10.1002/lt.25729 [doi]
AB  - The etiology and prognosis of acute liver failure (ALF) remains unknown in a 
      significant proportion of cases. Signs of autoimmunity may be present, but no 
      consistent pattern has been observed. We aimed to analyze if pretransplant 
      immunological findings, human leukocyte antigen (HLA) haplotypes, and clinical 
      features among patients with an unknown etiology differ from those of autoimmune 
      or other known etiologies. We also analyzed whether such signs impact 
      posttransplant biopsy findings or complications. All adult ALF patients 
      undergoing liver transplantation (LT) in Finland during 1987-2015 were followed 
      to 2016. Data were collected from the LT registry, pathology database, and 
      patient records. A total of 124 patients were included in the analysis. Study 
      subgroups were acute autoimmune hepatitis (AIH; n = 25), known non-AIH etiology 
      (n = 54), and unknown etiology (n = 45). The unknown etiology group differed from 
      the known non-AIH group with regard to the following pretransplant 
      autoimmunity-associated features: positive perinuclear anti-neutrophil 
      cytoplasmic antibodies (36% versus 8%; P = 0.02) and higher mean immunoglobulin A 
      (IgA; 3.2 +/- 1.7 versus 2.1 +/- 1.4, P = 0.006) and immunoglobulin G (IgG; 
      12.7 +/- 4.3 versus 8.5 +/- 3.6, P = 0.001). AIH-associated HLA haplotypes B8, DR3, 
      and B8DR3 were more common in the AIH group (40%, 44%, and 36%, respectively) and 
      in the unknown group (29%, 33%, and 29%, respectively) than in the known non-AIH 
      group (11%, 17%, and 11%, respectively) or in the Finnish general population 
      (17%, 18%, and 8%, respectively). However, these findings had no association with 
      protocol biopsies, extrahepatic autoimmune diseases, or survival. Patients 
      with >/= 1 rejection episode had higher pretransplant IgA (3.7 +/- 2.3 versus 2.6 +/- 
      1.2; P = 0.02) and IgG (16.4 +/- 10.2 versus 12.4 +/- 6.8; P = 0.03) than those 
      without rejections. Autoimmunity-associated pretransplant laboratory findings and 
      HLA haplotypes were common in ALF of unknown etiology, but they showed minimal 
      predictive value for posttransplant biopsy findings, clinical complications, or 
      survival.
CI  - Copyright (c) 2020 by the American Association for the Study of Liver Diseases.
FAU - Liukkonen, Ville
AU  - Liukkonen V
AD  - Department of Gastroenterology, Helsinki University Hospital, Helsinki, Finland.
FAU - Nordin, Arno
AU  - Nordin A
AD  - Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki, 
      Finland.
FAU - Arola, Johanna
AU  - Arola J
AD  - Department of Pathology, Laboratory of Helsinki University Hospital (HUSLAB), 
      University of Helsinki, Helsinki, Finland.
FAU - Farkkila, Martti
AU  - Farkkila M
AD  - Department of Gastroenterology, Helsinki University Hospital, Helsinki, Finland.
FAU - Aberg, Fredrik
AU  - Aberg F
AUID- ORCID: 0000-0002-3833-0705
AD  - Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki, 
      Finland.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20200511
PL  - United States
TA  - Liver Transpl
JT  - Liver transplantation : official publication of the American Association for the 
      Study of Liver Diseases and the International Liver Transplantation Society
JID - 100909185
SB  - IM
CIN - Liver Transpl. 2020 Jun;26(6):743-745. PMID: 32279421
CIN - Liver Transpl. 2021 Feb;27(2):309-310. PMID: 33047498
MH  - Adult
MH  - Autoimmunity
MH  - Biopsy
MH  - *Hepatitis, Autoimmune/diagnosis
MH  - Humans
MH  - *Liver Failure, Acute/diagnosis/etiology/surgery
MH  - *Liver Transplantation/adverse effects
EDAT- 2020/02/09 06:00
MHDA- 2021/03/19 06:00
CRDT- 2020/02/09 06:00
PHST- 2019/09/02 00:00 [received]
PHST- 2020/01/28 00:00 [accepted]
PHST- 2020/02/09 06:00 [pubmed]
PHST- 2021/03/19 06:00 [medline]
PHST- 2020/02/09 06:00 [entrez]
AID - 10.1002/lt.25729 [doi]
PST - ppublish
SO  - Liver Transpl. 2020 Jun;26(6):764-773. doi: 10.1002/lt.25729. Epub 2020 May 11.