Síndrome de superposición: hepatitis autoinmune y colangitis biliar primaria. Resultados a largo plazo de una cohorte retrospectiva en un hospital universitario

ABSTRACT: Background Autoimmune hepatitis (AIH) with characteristics of primary biliary cholangitis (PBC) is known as overlap syndrome. Its prevalence and prognosis have not yet been determined comparatively with AIH. Methods A retrospective cohort study was conducted comparing patients diagnosed with AIH and AIH-PBC overlap syndrome, followed-up for seven years in a university hospital in Colombia, until 31 December 2016. Results A total of 210 patients were included (195 women, mean age 48.5 years). Of these, 32 (15.2%) had AIH-PBC overlap syndrome. At diagnosis, no significant differences were found by demographic profile, positive autoantibodies (ANA, ASMA), except AMA (81.2% vs 3.9%, P < .001), and histological grade of fibrosis. The most frequent clinical presentations were nonspecific symptoms in AIH-PBC and acute hepatitis in AIH. Although there were no significant differences, AIH showed a greater biochemical response to immunosuppressive management (87.3% vs 74.2%, P = .061) and a greater number of relapses in those who achieved partial or complete remission during treatment (12.4% vs 7.63%; P = .727). Patients with AIH-PBC had greater progression to cirrhosis (22.2% vs 13.1%, P = .038), even in those who achieved partial or complete biochemical remission without relapse, with greater indication of orthotopic liver transplantation (P = .009), but not retransplantation (P = .183); there were no differences in mortality. Conclusions AIH-PBC overlap syndrome accounts for a significant proportion of patients with AIH, with greater progression to cirrhosis, indication of liver transplantation and possibly retransplantation. This higher risk of adverse outcomes suggests closer monitoring, probably with follow-up until confirmed histopathological remission.

• Autores: Martínez Casas, Omar Yesid; Díaz Ramírez, Gabriel Sebastián; Marín Zuluaga, Juan Ignacio; Santos Sánchez, Óscar Mauricio; Muñoz Maya, Octavio Germán; Donado Gómez, Jorge Hernando; Restrepo Gutiérrez, Juan Carlos
• Tipo de recurso: Article of investigation
• Fecha de publicación: 2018
• Institución: Universidad de Antioquia
• Repositorio: Repositorio UdeA
• Idioma: eng; spa
• OAI Identifier: oai:bibliotecadigital.udea.edu.co:10495/41453
• Acceso en línea: https://hdl.handle.net/10495/41453
• Palabra clave: Hepatitis Autoinmune; Hepatitis, Autoimmune; Cirrosis Hepática Biliar; Liver Cirrhosis, Biliary; Trasplante de Hígado; Liver Transplantation; Corticoesteroides; Adrenal Cortex Hormones; Colombia - epidemiología; Colombia - epidemiology; Inmunosupresores; Immunosuppressive Agents; Estudios de Seguimiento; Follow-Up Studies; Estudios Retrospectivos; Retrospective Studies; Ácido Ursodesoxicólico; Ursodeoxycholic Acid; https://id.nlm.nih.gov/mesh/D019693; https://id.nlm.nih.gov/mesh/D008105; https://id.nlm.nih.gov/mesh/D016031; https://id.nlm.nih.gov/mesh/D000305; https://id.nlm.nih.gov/mesh/D003105; https://id.nlm.nih.gov/mesh/D007166; https://id.nlm.nih.gov/mesh/D005500; https://id.nlm.nih.gov/mesh/D012189; https://id.nlm.nih.gov/mesh/D014580
• Rights: openAccess
• License: http://creativecommons.org/licenses/by-nc-nd/2.5/co/