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 23 June 2018

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News

Leading indicators for liver transplant in autoimmune disease

The current publication of Clinical Gastroenterology and Hepatology evaluates patients with autoimmune liver diseases on transplant waitlists.

News image

The rarity of autoimmune liver disease poses challenges to epidemiology studies.

However, waitlists for liver transplantation can be used to study patients with end-stage liver diseases.

Dr Hirschfield and colleagues of the United Kingdom used these waitlists to assess trends in numbers and demographics of patients awaiting liver transplant for primary biliary cholangitis, primary sclerosing cholangitis or autoimmune hepatitis.

The research team collected data from the United Kingdom and United States national registries for all adults on liver transplant waitlists, from 1995, through 2014.

The team analyzed data from patients with primary biliary cholangitis, primary sclerosing cholangitis and autoimmune hepatitis.

Numbers of listings per year were adjusted to the estimated populations during each year.

Regression analyses were used to examine trends, and comparative statistics were used to evaluate differences in individual characteristics among groups.

Over the total study period, listings for primary biliary cholangitis were 1.2 and 1.0 per million population per year in the United Kingdom and United States, respectively; for primary sclerosing cholangitis, 0.9 and 1.2 per million population per year; and for autoimmune hepatitis, 0.5 and 0.8 per million population per year.

Over the period studied, numbers of listings for primary biliary cholangitis decreased by 50% in both countries; changes in numbers of listings for primary sclerosing cholangitis and autoimmune hepatitis were smaller and not consistent between countries.

Primary biliary cholangitis decreased by almost 50% from 1995 through 2014
Clinical Gastroenterology and Hepatology


By 2014, primary sclerosing cholangitis had become the leading indication for liver transplantation among patients with autoimmune liver diseases in both countries.

The doctors found median patient ages at time of listing were lower than those reported as median age of diagnosis for autoimmune hepatitis and primary biliary cholangitis.

The researchers noted that the ratio of women:men with primary biliary cholangitis decreased by almost 50% from 1995 through 2014.

Men with primary sclerosing cholangitis were placed on the waitlist with higher disease severity scores than women in both countries.

The team found that among patients with primary biliary cholangitis, those of black race were under-represented on waitlists from both countries.

Among patients with primary sclerosing cholangitis, Hispanics were under-represented on waitlists in the United States.

Patients of non-white races were placed on waitlists at younger ages for all diseases; age differences in waitlist placement varied by up to 10 years, depending on race, among patients with primary biliary cholangitis.

Dr Hirschfield's team comments, "In an analysis of data collected from the United Kingdom and United States national liver transplant registries over 20 years, we found that primary sclerosing cholangitis has become the leading indication for liver transplantation among patients with autoimmune liver diseases."

"Numbers of patients with primary biliary cholangitis placed on waitlists, and the ratio of women:men with primary biliary cholangitis, each decreased by almost 50%, possibly due to increased treatment with ursodeoxycholic acid."

"Within groups of patients on the transplant waitlist for primary biliary cholangitis, primary sclerosing cholangitis, or utoimmune hepatitis, we found differences in age, sex, disease severity scores, and ethnicity between diseases and countries that require further study."

Clin Gastroenterol Hepatol 2018:16(2): 278-287.e7
27 February 2018

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