SNFGE SNFGE
 
Thématique :
- Foie
Originalité :
Réexamen
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2015/11  
 
  2015 Nov;62(5):1524-35  
  doi: 10.1002/hep.27983  
 
  Prediction of short- and long-term outcome in patients with autoimmune hepatitis  
 
  Kirstein MM, Metzler F, Geiger E, Heinrich E, Hallensleben M, Manns MP, Vogel A  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=Prediction+of+short+and+long+term+outcome+in+patients+with+autoimmune+hepatitis  
 
 

Autoimmune hepatitis (AIH) is a chronic inflammatory disease characterized by a loss of tolerance toward the hepatocellular epithelium. Liver transplantation (LT) represents the ultimate therapeutic option for a fulminant course or end-stage liver disease. The aim of this study was to elucidate the clinical, serological, and genetic features of remission, relapse, and overall and LT-free survival. Between 2000 and 2014, 354 AIH patients from Hannover Medical School were included. Clinical, laboratory, and histological reports were analyzed. DRB1 allele analyses were performed in 264 AIH and 399 non-AIH patients. Cox's regression analysis was performed to identify factors significantly associated with survival. Patients diagnosed in childhood were at higher risk for relapses (P = 0.003), requirement for LTs (P = 0.014, log rank), and had a reduced life expectancy (P < 0.001, log rank). Detection of soluble liver antigen/liver pancreas antigen (SLA/LP) antibodies was significantly associated with reduced overall and LT-free survival (P = 0.037; P = 0.021). Cirrhosis, which was evident in 25% at first diagnosis, was found to be a predictor of poor survival and requirement for LT (P = 0.003; P = 0.009). DRB1*04:01-positive phenotype was associated with a higher rate of complete remissions and with a lower frequency of cirrhosis and LTs. There were no significant differences for subsequent relapses or survival in patients achieving either partial or complete remission.

CONCLUSION:

Diagnosis <18 years, histological cirrhosis at first diagnosis and SLA/LP antibodies are major risk factors for a poor short- and long-term outcome. These patients are in need of high surveillance. Separating patients with positive SLA/LP antibodies into a third group may be reconsidered. DRB1*04:01 positivity has been identified in association with a favorable clinical outcome. (Hepatology 2015;62:1524-1535).

 
Question posée
 
Concernant l’hépatite auto-immune, quels sont les facteurs cliniques, sérologiques et génétiques associés à la rémission, la rechute, la survie globale et la survie sans transplantation hépatique ?
 
Question posée
 
Les patients diagnostiqués dans l’enfance sont à plus fort risque de rechute, d’être transplantés et ont une survie diminuée. La présence d’ac SLA/LP est associée à une diminution de la survie. La cirrhose présente dans un quart des cas au diagnostic est associée évidemment à une survie diminuée et à la transplantation hépatique. DRB1*04 :01 est associé à un taux plus élevé de rémission avec une fréquence plus faible de cirrhose et de recours à la transplantation hépatique.
 
Commentaires

Le dosage des ac SLA/LP est assez simple et pourrait donc être un outil intéressant et inciter à une surveillance plus serrée et un traitement le plus adapté.

 
www.snfge.org