studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 367A
grounds. There is insufficient evidence about the prevalence
of AIH among people of color.We sought to determine the
racial/ethnic distribution of AIH cases in an ethnically diverse,
urban, county hospital system. We performed an observational
cohort study. A consecutive sample of patients with a diagnosis
of AIH or AIH-PBC overlap syndrome per AASLD guidelines
from September 2013 to April 2015 was included in
the study. Demographic, clinical, laboratory, radiographic,
and histologic data were collected. The characteristics of the
cohort were compared with the published data on the patient
population served by the integrated hospital system using the
chi-squared test. The characteristics of different ethnic groups
were compared using univariate and multivariate analysis. 23
patients with AIH (6 had overlap syndrome) were seen in the
hepatology clinic over the 20-month period. AIH occurred in
significantly fewer white patients than would be expected if the
prevalence were equal among ethnic groups, given the demographics
of this integrated hospital system (Table, p=0.03).
The median age at diagnosis was 49 years (range 18-91) and
18 (78%) were female. At diagnosis, the median total bilirubin
was 3.3 mg/dL, ALT was 483 U/L, IgG was 1995 mg/dL, INR
was 1.2, albumin was 3.8 g/dL, and platelet count was 177
k/uL. 19 patients had complete liver biopsy results, and ten
(53%) had fibrosis stage ≥2, with four (21%) having advanced
(stage 3-4) fibrosis. When stratified by Latino ethnicity, Latinos
did not differ significantly from non-Latinos in terms of age at
diagnosis, baseline labs, or severity of liver fibrosis. A two-predictor
model that adjusted for age found no significant association
between Latino ethnicity and fibrosis stage. AIH was
significantly more prevalent among people of color (especially
Latinos) suggesting that AIH may not affect all ethnic groups
equally. Although the disease characteristics did not appear
to differ by ethnicity, this disparity may be related to genetic,
socioeconomic, environmental, or comorbid medical factors.
Disclosures:
Mandana Khalili - Consulting: Gilead Sciences Inc; Grant/Research Support:
Gilead Sciences INc, Bristal Myer Squibb
Jacquelyn J. Maher - Consulting: Durect
The following authors have nothing to disclose: Michele M. Tana, Edward W.
Holt, Robert J. Wong, Justin L. Sewell
307
Outcomes and mortality of de novo autoimmune hepatitis
after liver transplantation
Aishwarya Kuchipudi 1 , Ryan Morton 3 , Sarah Y. Chan 3 , Dilip
Moonka 2 , Kimberly Ann Brown 2 , Syed M. Jafri 2 ; 1 Internal Medicine,
Henry Ford Hospital, Detroit, MI; 2 Gastroenterology, Henry
Ford Hospital, Detroit, MI; 3 Wayne State University School of Medicine,
Detroit, MI
Aim: To evaluate the incidence and outcomes of de novo Autoimmune
Hepatitis (AIH) in patients with history of Orthotopic
Liver Transplantation (OLT). Methods: We performed a retrospective
chart review of 1343 OLT patients from 2000-2015.
We identified patients with histopathological evidence of de
novo AIH. Patients with biopsy features consistent with AIH
pre-OLT and those with Hepatitis C were excluded from analysis.
For each patient with de novo AIH, we identified 2 controls
wherever possible, matched for etiology of liver disease
and date of transplant (+/- 18 months). We then compared
the two groups on factors including intra-operative or post-operative
complications, immunosuppression levels at specific
time points, development of fibrosis/cirrhosis, progression
to re-transplant and mortality at 1, 3 & 5 years respectively.
Results: Of 1343 patients who received an OLT, 6 developed
de novo AIH. The etiology of initial liver failure was alcohol in
3 of these patients; and steatohepatitis, cryptogenic hepatocellular
carcinoma, primary sclerosing cholangitis in one patient
each. We identified a total of 11 matched controls for these
patients. Mean donor age was 45 years in the de novo group
and 40 years in the control group (p=0.62). 2 patients in the
de novo group and 4 in the control group developed biliary
stricture post-operatively. One of the control patients developed
post-op cholestasis. Mean Tacrolimus levels at week 1; week
12, 6 months and 1 year were not statistically different. Mean
Tacrolimus levels at week 4 was 10 in the de novo AIH group
and 5.41 in the control group (p= 0.02). At 1 year, levels
were 8.53 in the de novo group and 7.0 in the control group
(p=0.61). The average time to development of de novo AIH
was 1096 days (range 31-2822 days). Mean total prednisone
used was 2697 mg in the de novo group and 1711 mg in the
control group (p=0.60). Three de novo patients were noted
to have fibrosis at the time of diagnosis (2 with severe fibrosis
and 1 with mild fibrosis) and 1 control patient developed
mild fibrosis (p=0.09). 1 de novo patient developed cirrhosis
(788 days), none of the controls did. None of the patients
received a re-transplantation. Survival at 1 year was 100% in
the de novo group and 82% in the control group. Survival at 3
years was 80% and 82% respectively. Survival at 5 years was
40% and 82% respectively (p=0.34). Two deaths in the control
group and one death in the de novo group were attributed to
infection. Conclusion. De novo AIH is relatively rare post-OLT.
It might be associated with a higher potential for significant
fibrosis and increased mortality.
Disclosures:
Dilip Moonka - Advisory Committees or Review Panels: Gilead; Grant/Research
Support: Bristol-Myers Squibb; Speaking and Teaching: AbbVie, Gilead
Kimberly Ann Brown - Advisory Committees or Review Panels: CLDF, Merck,
BMS, ABBVIE, Gilead, Gilead, Janssen, Salix; Consulting: Blue Cross Transplant
Centers; Grant/Research Support: CLDF, Gilead, Exalenz, CDC, BMS, Hyperion,
Merck; Speaking and Teaching: ABBVIE, Gilead, CLDF
The following authors have nothing to disclose: Aishwarya Kuchipudi, Ryan
Morton, Sarah Y. Chan, Syed M. Jafri