Ynto S de Boer1, Alessio Gerussi2, Floris F van den Brand3, Guan-Wee Wong4, Neil Halliday5, Rodrigo Liberal4, Joost P H Drenth6, Douglas Thorburn7, Gerd Bouma3, Michael A Heneghan8. 1. Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers - VU University Medical Center, Amsterdam, the Netherlands; Institute of Liver Studies, King's College Hospital, Denmark Hill, London, London, United Kingdom. 2. Sheila Sherlock Liver Centre and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom; Department of Medicine, University of Udine, Udine, Italy. 3. Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers - VU University Medical Center, Amsterdam, the Netherlands. 4. Institute of Liver Studies, King's College Hospital, Denmark Hill, London, London, United Kingdom. 5. Sheila Sherlock Liver Centre and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom; Institute of Immunity and Transplantation, Division of Infection and Immunity, University College London, Royal Free Hospital, London, United Kingdom. 6. Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands. 7. Sheila Sherlock Liver Centre and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom. 8. Institute of Liver Studies, King's College Hospital, Denmark Hill, London, London, United Kingdom. Electronic address: michael.heneghan@nhs.net.
Abstract
INTRODUCTION & AIMS: Small studies have found that black patients with autoimmune hepatitis (AIH) present with more aggressive disease. We aimed to characterize the presentation and outcome in black and white patients with AIH. METHODS: We performed a retrospective study, collecting information from databases of patients with AIH attending the Institute of Liver studies at King's College Hospital, London (1971-October 2015, the Royal Free Hospital, London (1982 through December 2016) and the multicenter Dutch Autoimmune Hepatitis Study Group cohort (2006-August 2016). We identified 88 black patients with AIH and we compared their clinical characteristics and outcomes to 897 white patients with AIH. RESULTS: Black patients presented at a younger age (median 38 years vs 45 years) (P = .007), had higher IgG levels (mean 31.0 mg/dL vs 27.5 mg/dL) (P = .04), but there were no significant differences between groups in auto-antibody profiles, International AIH Group scores, or sex distribution of disease. A higher proportion of black patients had systemic lupus erythematosus (10%) than white patients (2%) (P ≤ .001). There was no significant difference in proportions of patients with a response to standard therapy (86% for black patients vs 91% for white patients; P = .20) or in rate of relapse (57% vs 50%; P = .3). Despite this, black patients had an increased risk of liver transplantation and liver-related death (hazard ratio 2.4, 95% confidence interval, 1.4-4.0; P < .001). Overall mortality was similar between the two groups. CONCLUSION: In a comparison of black and white patients with AIH in Europe, we found that black patients present at a younger age, have higher levels of IgG levels, and a greater proportion have SLE. We also found black patients to have a greater risk of liver transplantation and liver-related mortality, indicating more aggressive disease.
INTRODUCTION & AIMS: Small studies have found that black patients with autoimmune hepatitis (AIH) present with more aggressive disease. We aimed to characterize the presentation and outcome in black and white patients with AIH. METHODS: We performed a retrospective study, collecting information from databases of patients with AIH attending the Institute of Liver studies at King's College Hospital, London (1971-October 2015, the Royal Free Hospital, London (1982 through December 2016) and the multicenter Dutch Autoimmune Hepatitis Study Group cohort (2006-August 2016). We identified 88 black patients with AIH and we compared their clinical characteristics and outcomes to 897 white patients with AIH. RESULTS: Black patients presented at a younger age (median 38 years vs 45 years) (P = .007), had higher IgG levels (mean 31.0 mg/dL vs 27.5 mg/dL) (P = .04), but there were no significant differences between groups in auto-antibody profiles, International AIH Group scores, or sex distribution of disease. A higher proportion of black patients had systemic lupus erythematosus (10%) than white patients (2%) (P ≤ .001). There was no significant difference in proportions of patients with a response to standard therapy (86% for black patients vs 91% for white patients; P = .20) or in rate of relapse (57% vs 50%; P = .3). Despite this, black patients had an increased risk of liver transplantation and liver-related death (hazard ratio 2.4, 95% confidence interval, 1.4-4.0; P < .001). Overall mortality was similar between the two groups. CONCLUSION: In a comparison of black and white patients with AIH in Europe, we found that black patients present at a younger age, have higher levels of IgG levels, and a greater proportion have SLE. We also found black patients to have a greater risk of liver transplantation and liver-related mortality, indicating more aggressive disease.
Authors: Nahel A Tunio; Emad Mansoor; Mohammed Z Sheriff; Gregory S Cooper; Seth N Sclair; Stanley M Cohen Journal: J Clin Gastroenterol Date: 2021 Nov-Dec 01 Impact factor: 3.062
Authors: Maaike Biewenga; Xavier P D M J Verhelst; Martine A M C Baven-Pronk; Hein Putter; Aad P van den Berg; Karin C M J van Nieuwkerk; Henk R van Buuren; Gerd Bouma; Ynte S de Boer; Cedric Simoen; Isabelle Colle; Jeoffrey Schouten; Filip Sermon; Christophe van Steenkiste; Hans van Vlierberghe; Adriaan J van der Meer; Frederik Nevens; Bart van Hoek Journal: United European Gastroenterol J Date: 2021-06-24 Impact factor: 4.623