Autoimmune liver diseases, hepatocellular carcinoma, and recurrence of autoimmunity post-liver transplantation

Wang, Sarah; Dong, Victor; Montaño-Loza, Aldo J.; Mason, Andrew L.

doi:10.20517/2394-5079.2020.163

Cited by 3 publications

(4 citation statements)

References 106 publications

(181 reference statements)

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“…The incidence of HCC in AIH is 3.06 per 1000 person-years while it is 4.1 per 1000 person-years for PBC. These data support the importance of regular monitoring of disease severity in AIH and PBC, with initiation of HCC screening in patients who progress to cirrhosis [22].…”

Section: Autoimmune Hepatitis and Primary Biliary Cholangitissupporting

confidence: 68%

Underlying Liver Disease

Pellicelli

2022

Hepatocellular Carcinoma

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Section: Autoimmune Hepatitis and Primary Biliary Cholangitissupporting

confidence: 68%

Underlying Liver Disease

Pellicelli

2022

Hepatocellular Carcinoma

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“…A multi-national metanalysis of over 16,000 PBC patients reported an increased relative risk of hepatocellular carcinoma (HCC), breast cancer, lymphoma, renal cancer and other female hormone responsive cancers [ 87 ]. While PBC patients are at increased risk of HCC, it is notable that all patients with cirrhosis have increased risk of HCC as well [ 87 , 88 , 89 ]. Therefore, it is not possible to infer that HBRV may be linked with HCC or breast cancer based on the epidemiological data alone.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it is not possible to infer that HBRV may be linked with HCC or breast cancer based on the epidemiological data alone. However, patients with chronic viral hepatitis, including those with either hepatitis B or hepatitis C virus infection, usually have a far higher risk of HCC as compared to non-viral causes of cirrhosis [ 89 ].…”

Section: Discussionmentioning

confidence: 99%

Isolation of a Human Betaretrovirus from Patients with Primary Biliary Cholangitis

Goubran

Wang

Indik

et al. 2022

Viruses

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A human betaretrovirus (HBRV) has been linked with the autoimmune liver disease, primary biliary cholangitis (PBC), and various cancers, including breast cancer and lymphoma. HBRV is closely related to the mouse mammary tumor virus, and represents the only exogenous betaretrovirus characterized in humans to date. Evidence of infection in patients with PBC has been demonstrated through the identification of proviral integration sites in lymphoid tissue, the major reservoir of infection, as well as biliary epithelium, which is the site of the disease process. Accordingly, we tested the hypothesis that patients with PBC harbor a transmissible betaretrovirus by co-cultivation of PBC patients’ lymph node homogenates with the HS578T breast cancer line. Because of the low level of HBRV replication, betaretrovirus producing cells were subcloned to optimize viral isolation and production. Evidence of infection was provided by electron microscopy, RT-PCR, in situ hybridization, cloning of the HBRV proviral genome and demonstration of more than 3400 integration sites. Further evidence of viral transmissibility was demonstrated by infection of biliary epithelial cells. While HBRV did not show a preference for integration proximal to specific genomic features, analyses of common insertion sites revealed evidence of integration proximal to cancer associated genes. These studies demonstrate the isolation of HBRV with features similar to mouse mammary tumor virus and confirm that patients with PBC display evidence of a transmissible viral infection.

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“…Mean observed time from LT to recurrence is 5 years. It has been reported in the range of 36% to 68% after 5 years [ 32 ]. Recurrence rates of AIH tend to increase with time.…”

Section: Discussionmentioning

confidence: 99%

Pediatric liver transplantation for autoimmune liver disease: Ten-year experience from a liver transplant center in India

Mittal

Kumar

Malhotra

et al. 2022

Indian J Gastroenterol

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Liver transplantation (LT) has emerged as the best therapeutic modality for end-stage liver disease in pediatric autoimmune liver disease (AILD). We aimed to describe our experience of pediatric living donor liver transplantation for AILD from India over a period of 10 years. We did a retrospective analysis of 244 liver transplants at our center over the last 10 years to identify children with AILD (18 years or younger). We aimed to describe the demographic features, clinical profile, graft survival, patient outcome, and predictors of mortality in our cohort. Between July 2010 and May 2020, 13 liver transplants were performed for AILD out of total 244 children transplanted over the last 10 years at our center. Mean (standard deviation [SD]) age at LT was 12 (± 3.84) years. Leading indications for LT were decompensated liver disease (61.5%), acute-on-chronic liver failure (23.1%), acute liver failure (ALF) (7.7%), and recurrent cholangitis and growth failure (7.7%). Mean Pediatric End-stage Liver Disease (PELD) score/model for end-stage liver disease (MELD) score and international normalized ratio (INR) (SD) at presentation were 24 (± 12.81) and 2.48 (± 1.54), respectively. Median discharge duration was 23 days (interquartile range [IQR] 21–36 days). 30.7% (4/13) of the subjects had no postoperative complications. Diarrhea (15.3%), pneumonia (7.7%), jejunostomy site bleed (7.7%), tacrolimus toxicity (7.7%), and vascular complications (7.7%) were seen, which resolved with satisfactory graft function. Three subjects died post-LT; causes of death included sepsis ( n =3), renal dysfunction ( n =1), and pneumonia ( n =1). Others have been well on follow-up with no graft rejection or need for re-transplantation. Overall, 1-year and 5-year patient survival rates were 76.9% and 70%, respectively. Lower platelet count, autoimmune hepatitis (AIH) 2, and PELD/MELD score were found to be significant predictors of mortality on univariate analysis, which were not significant on multivariate modelling. The complications, graft and patient survival rates in our experience were quite encouraging, and are comparable with the best centers worldwide. After instituting appropriate treatment, early referral of such patients to an equipped center should be facilitated. Supplementary Information The online version contains supplementary material available at 10.1007/s12664-022-01282-z.

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Autoimmune liver diseases, hepatocellular carcinoma, and recurrence of autoimmunity post-liver transplantation

Cited by 3 publications

References 106 publications

Underlying Liver Disease

Underlying Liver Disease

Isolation of a Human Betaretrovirus from Patients with Primary Biliary Cholangitis

Pediatric liver transplantation for autoimmune liver disease: Ten-year experience from a liver transplant center in India

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