ASSOCIATE EDITORS Frank A. Anania, Atlanta, GA Jorge A. Bezerra, Cincinnati, OH Raymond T. Chung, Boston, MA Eithan Galun, Jerusalem, Israel Guadalupe Garcia-Tsao, New Haven, CT Stephen A. Harrison, Fort Sam Houston, TX Brett Lindenbach, New Haven, CT Jacquelyn Maher, San Francisco, CA Wajahat Mehal, New Haven, CT Lola M. Reid, Chapel Hill, NC Mario Strazzabosco, New Haven, CT Norah Terrault, San Francisco, CA Snorri S. Thorgeirsson, Bethesda, MD Michael Trauner, Vienna, Austria

Review of recent research on hepatitis C therapy for 54th annual meeting of the American association for the study of liver diseases

EASL Clinical Practice Guidelines: Autoimmune hepatitis

https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep.31065

Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases.

Autoimmune hepatitis (AIH) is a severe liver disease that arises in genetically predisposed male and female individuals worldwide. Diagnosis of AIH is made clinically applying diagnostic scores; however, the heterotopic disease phenotype often makes a rapid determination of disease challenging. AIH responds favorably to steroids and pharmacologic immunosuppression, and liver transplantation is only necessary in cases with acute liver failure or end-stage liver cirrhosis. Recurrence or development of de novo AIH after transplantation is possible, and treatment is similar to standard AIH therapy. Current experimental investigations of T cell-mediated autoimmune pathways and analysis of changes within the intestinal microbiome might advance our knowledge on the pathogenesis of AIH and trigger a spark of hope for novel therapeutic strategies.

/pdf/autoimmune-hepatitis-immunologically-triggered-liver-3hh0v2ucfp.pdf

Autoimmune Hepatitis-Immunologically Triggered Liver Pathogenesis-Diagnostic and Therapeutic Strategies.

SummaryBackground
Autoimmune liver diseases (AILD) constitute the third most common indication for liver transplantation (LT) worldwide. Outcomes post LT are generally good but recurrent disease is frequently observed.

Aims
To describe the frequency and risk factors associated with recurrent AILD post-LT and provide recommendations to reduce the incidence of recurrence based on levels of evidence.

Methods
A systematic review was performed for full-text papers published in English-language journals, using the keywords ‘autoimmune hepatitis (AIH)’, ‘primary biliary cholangitis and/or cirrhosis (PBC)’, ‘primary sclerosing cholangitis (PSC)’, ‘liver transplantation’ and ‘recurrent disease’. Management strategies to reduce recurrence after LT were classified according to grade and level of evidence.

Results
Survival rates post-LT are approximately 90% and 70% at 1 and 5 years and recurrent disease occurs in a range of 10–50% of patients with AILD. Recurrent AIH is associated with elevated liver enzymes and IgG before LT, lymphoplasmacytic infiltrates in the explants and lack of steroids after LT (Grade B). Tacrolimus use is associated with increased risk; use of ciclosporin and preventive ursodeoxycholic acid with reduced risk of PBC recurrence (all Grade B). Intact colon, active ulcerative colitis and early cholestasis are associated with recurrent PSC (Grade B).

Conclusions
Recommendations based on grade A level of evidence are lacking. The need for further study and management includes active immunosuppression before liver transplantation and steroid use after liver transplantation in autoimmune hepatitis; selective immunosuppression with ciclosporin and preventive ursodeoxycholic acid treatment for primary biliary cholangitis; and improved control of inflammatory bowel disease or even colectomy in primary sclerosing cholangitis.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/apt.13894

Systematic review: recurrent autoimmune liver diseases after liver transplantation

Background/Aims

De novo autoimmune hepatitis (AIH) describes the development of hepatitis with autoimmune features in liver transplant (LT) patients without prior diagnosis of AIH. We aimed to evaluate the incidence and risk factors for de novo AIH.



Methods

A cohort of 576 patients with LT for aetiologies other than AIH was evaluated.



Results

De novo AIH was diagnosed in 17 patients (3%) with an overall incidence of 4.0 cases per 1000 patient-years. By univariate Cox analysis, patients who received cyclosporine A had lower risk (HR 0.24, 95% CI 0.07–0.80, P = 0.02), whereas patients who had female donors (HR 3.03, 95% CI 1.11–8.25, P = 0.03), donors ≥40-years (HR 6.95, 95% CI 1.93–25.03, P = 0.003), and those who received tacrolimus (HR 4.39, 95% CI 1.47–13.13, P = 0.008) and mycophenolate mofetil (HR 6.37, 95% CI 1.62–25.13, P = 0.008) had higher risk. Survival was similar in patients with de novo AIH compared with the LT population (mean survival time, 17 ± 1.5 vs. 16 ± 0.5 years, Log-rank test; P = 0.4).



Conclusions

The incidence of de novo AIH is low and does not impact on long-term survival. Recipients of female or older donor grafts, or recipients using tacrolimus, or mycophenolate mofetil as part of their immunosuppressive regimen have a higher risk of de novo AIH, whereas LT recipients maintained on cyclosporine A have a lower risk.

Incidence and risk factors associated with de novo autoimmune hepatitis after liver transplantation

/pdf/caep-position-statement-on-improving-emergency-care-for-3e47ctx6.pdf

CAEP position statement on improving emergency care for persons experiencing homelessness: executive summary

/pdf/caep-position-statement-on-improving-emergency-care-for-px6bym0l.pdf

CAEP position statement on improving emergency care for persons experiencing homelessness: executive summary

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Incidence and risk factors associated with de novo autoimmune hepatitis after liver transplantation

CAEP position statement on improving emergency care for persons experiencing homelessness: executive summary

CAEP position statement on improving emergency care for persons experiencing homelessness: executive summary