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Older Age and Disease Duration Are Highly Associated with Hepatocellular Carcinoma in Patients with Autoimmune Hepatitis

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Abstract

Background

Hepatocellular carcinoma (HCC) is rare in patients with autoimmune hepatitis (AIH). However, the overall burden of AIH cirrhosis in causing HCC and patients’ risk factors are not well understood.

Aims

To characterize the proportion of HCC linked to AIH at a large academic health center, and to identify variables associated with HCC in patients with AIH in a case–control study design.

Methods

Over a 14.5-year period, medical records of all patients with HCC were reviewed. Cases are AIH patients identified from the cohort, and controls are patients with AIH without HCC. Three controls were randomly chosen from the Genetic Repository of Autoimmune Liver Disease and Coexisting Exposures database for each eligible case.

Results

Out of 1250 eligible patients, 20 were linked to AIH (1.6%). Their median age was 64 years, 40% men and 100% Caucasian. Ten percent of AIH patients did not have evidence of cirrhosis at HCC diagnosis. The proportion of HCCs due to AIH decreased during the time intervals of the study. Compared to controls, cases were more likely men (40.0% vs. 18%, p = 0.049), with longer AIH duration (median 16 years vs. 5 years, p = 0.004). Prolonged AIH duration (OR 1.68, p = 0.006) and older age (OR 1.15, p = 0.049) were risk factors for HCC.

Conclusions

AIH is a rare cause (1.6%) for HCC in Midwestern USA with a decreasing trend over 14.5 years. Ten percent of AIH-HCC patients did not have cirrhosis at time of HCC diagnosis. Patients with prolonged duration of the disease and older age are at high risk to develop HCC.

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Abbreviations

AIH:

Autoimmune hepatitis

HCC:

Hepatocellular carcinoma

GRACE:

Genetic Repository of Autoimmune Liver Disease and Coexisting Exposures

ANA:

Antinuclear antibodies

ASMA:

Anti-smooth muscle antibodies

SD:

Standard deviation

IQR:

Interquartile range

NAFLD:

Nonalcoholic fatty liver disease

BMI:

Body mass index

MELD:

Model for End-Stage Liver Disease

UDCA:

Ursodeoxycholic acid

APRI:

AST-to-platelet ratio index

AFP:

Alpha-fetoprotein

BCLC:

Barcelona Clinic Liver Cancer

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, 46202, USA

    Lara Dakhoul, Keaton R. Jones, Samer Gawrieh, Marwan Ghabril, Raj Vuppalanchi, Eduardo Vilar-Gomez, Lauren Nephew, Naga Chalasani & Craig Lammert

  2. Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    Chelsey McShane

Authors
  1. Lara Dakhoul
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  2. Keaton R. Jones
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  3. Samer Gawrieh
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  4. Marwan Ghabril
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  5. Chelsey McShane
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  6. Raj Vuppalanchi
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  7. Eduardo Vilar-Gomez
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  8. Lauren Nephew
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  9. Naga Chalasani
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  10. Craig Lammert
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Corresponding authors

Correspondence to Naga Chalasani or Craig Lammert.

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Authors declare no conflicts of interest relevant for this paper.

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Dakhoul, L., Jones, K.R., Gawrieh, S. et al. Older Age and Disease Duration Are Highly Associated with Hepatocellular Carcinoma in Patients with Autoimmune Hepatitis. Dig Dis Sci 64, 1705–1710 (2019). https://doi.org/10.1007/s10620-018-5441-5

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  • DOI: https://doi.org/10.1007/s10620-018-5441-5

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