BACKGROUND Primary biliary cholangitis(PBC)is a serious disease that causes significant morbidity.PBC is confirmed with liver biopsy but autoantibodies are frequently used as proxies for diagnosis.The performance of a...BACKGROUND Primary biliary cholangitis(PBC)is a serious disease that causes significant morbidity.PBC is confirmed with liver biopsy but autoantibodies are frequently used as proxies for diagnosis.The performance of autoantibodies for the diagnosis of PBC seems to vary widely across populations.AIM To assess the diagnostic performance of several autoantibodies for the diagnosis of PBC in Latin American individuals.METHODS We studied 85 female adult Colombians,43 cases with biopsy-confirmed PBC and 42 controls in whom a liver biopsy ruled out PBC.Plasma anti-mitochondrial antibodies(AMAs),anti-smooth muscle antibodies(ASMAs)and anti-nuclear antibodies(ANAs),as well as total immunoglobulin(Ig)M and IgG were determined using immunofluorescence or enzyme-linked immunosorbent assay in all study participants within 1 year of the biopsy.For all variables,values analyzed were those closest to the date of the biopsy.Patients with viral or alcoholic hepatitis were excluded.RESULTS Mean age at diagnosis was 58.7 years for cases and 56.9 years for controls,and the body mass index was lower among cases.Most cases received ursodeoxycholic acid,while most controls received vitamin E.Sjögren syndrome and Hashimoto’s thyroiditis were the most frequent autoimmune comorbidities of PBC.The prevalence of AMA positivity among PBC cases was unexpectedly low.The sensitivity and specificity values were respectively 44.2%and 76.2%for AMA,74.4%and 38.1%for ANA,14.0%and 73.8%for ASMA,26.7%and 80.0%for IgG,and 57.1%and 85.7%for IgM.The combination of positive AMA plus positive IgM had 91%positive predictive value for PBC.Among AMA-negative cases,the most prevalent antibodies were ANA(87.5%).In all,62%of AMA-positive and 84.6%of IgM-positive individuals had fibrosis in their biopsy.CONCLUSION AMA positivity was very low among female Latin American patients with PBC.The performance of all antibodies was quite limited.These results highlight the urgent need for better PBC biomarkers.展开更多
BACKGROUND There is a nationwide shortage of organs available for liver transplantation.Living donors help meet this growing demand.Not uncommonly,donors will have positive autoantibodies.However,it is unclear whether...BACKGROUND There is a nationwide shortage of organs available for liver transplantation.Living donors help meet this growing demand.Not uncommonly,donors will have positive autoantibodies.However,it is unclear whether donor positive autoantibodies are correlated with worse outcomes following living liver donor transplantations.AIM To analyze the significance of positive autoantibodies in donors on post-transplant outcomes in recipients.METHODS We performed a retrospective review of living liver donors who had undergone liver transplantation between January 1,2012 and August 31,2021.Demographic characteristics and pre-transplant data including antinuclear antibodies(ANA)and anti-smooth muscle antibody titers were collected in donors.Outcomes of interest were post-transplantation complications including mortality,biliary strictures,biliary leaks,infection,and rejection.Pediatric recipients and donors without measured pre-transplant autoantibody serologies were excluded from this study.RESULTS 172 living donor liver transplantations were performed during the study period,of which 115 patients met inclusion criteria.37(32%)living donors were autoantibody-positive with a median ANA titer of 1:160(range 1:80 to 1:1280)and median anti-SMA titer of 1:40(range 1:20 to 1:160).There were no significant differences in baseline demographics between the autoantibody positive and negative donors.Post-transplantation rates of death(P value=1),infections(P value=0.66),and overall rates of complications(P value=0.52)were similar between the autoantibody positive and negative groups.Higher incidences of anastomotic strictures and rejection were observed in the autoantibody positive group;however,these differences were not statistically significant(P value=0.07 and P value=0.30 respectively).CONCLUSION Isolated pre-transplant autoantibody positivity is not correlated to worse post-transplant outcomes in living liver donor transplants.展开更多
文摘BACKGROUND Primary biliary cholangitis(PBC)is a serious disease that causes significant morbidity.PBC is confirmed with liver biopsy but autoantibodies are frequently used as proxies for diagnosis.The performance of autoantibodies for the diagnosis of PBC seems to vary widely across populations.AIM To assess the diagnostic performance of several autoantibodies for the diagnosis of PBC in Latin American individuals.METHODS We studied 85 female adult Colombians,43 cases with biopsy-confirmed PBC and 42 controls in whom a liver biopsy ruled out PBC.Plasma anti-mitochondrial antibodies(AMAs),anti-smooth muscle antibodies(ASMAs)and anti-nuclear antibodies(ANAs),as well as total immunoglobulin(Ig)M and IgG were determined using immunofluorescence or enzyme-linked immunosorbent assay in all study participants within 1 year of the biopsy.For all variables,values analyzed were those closest to the date of the biopsy.Patients with viral or alcoholic hepatitis were excluded.RESULTS Mean age at diagnosis was 58.7 years for cases and 56.9 years for controls,and the body mass index was lower among cases.Most cases received ursodeoxycholic acid,while most controls received vitamin E.Sjögren syndrome and Hashimoto’s thyroiditis were the most frequent autoimmune comorbidities of PBC.The prevalence of AMA positivity among PBC cases was unexpectedly low.The sensitivity and specificity values were respectively 44.2%and 76.2%for AMA,74.4%and 38.1%for ANA,14.0%and 73.8%for ASMA,26.7%and 80.0%for IgG,and 57.1%and 85.7%for IgM.The combination of positive AMA plus positive IgM had 91%positive predictive value for PBC.Among AMA-negative cases,the most prevalent antibodies were ANA(87.5%).In all,62%of AMA-positive and 84.6%of IgM-positive individuals had fibrosis in their biopsy.CONCLUSION AMA positivity was very low among female Latin American patients with PBC.The performance of all antibodies was quite limited.These results highlight the urgent need for better PBC biomarkers.
文摘BACKGROUND There is a nationwide shortage of organs available for liver transplantation.Living donors help meet this growing demand.Not uncommonly,donors will have positive autoantibodies.However,it is unclear whether donor positive autoantibodies are correlated with worse outcomes following living liver donor transplantations.AIM To analyze the significance of positive autoantibodies in donors on post-transplant outcomes in recipients.METHODS We performed a retrospective review of living liver donors who had undergone liver transplantation between January 1,2012 and August 31,2021.Demographic characteristics and pre-transplant data including antinuclear antibodies(ANA)and anti-smooth muscle antibody titers were collected in donors.Outcomes of interest were post-transplantation complications including mortality,biliary strictures,biliary leaks,infection,and rejection.Pediatric recipients and donors without measured pre-transplant autoantibody serologies were excluded from this study.RESULTS 172 living donor liver transplantations were performed during the study period,of which 115 patients met inclusion criteria.37(32%)living donors were autoantibody-positive with a median ANA titer of 1:160(range 1:80 to 1:1280)and median anti-SMA titer of 1:40(range 1:20 to 1:160).There were no significant differences in baseline demographics between the autoantibody positive and negative donors.Post-transplantation rates of death(P value=1),infections(P value=0.66),and overall rates of complications(P value=0.52)were similar between the autoantibody positive and negative groups.Higher incidences of anastomotic strictures and rejection were observed in the autoantibody positive group;however,these differences were not statistically significant(P value=0.07 and P value=0.30 respectively).CONCLUSION Isolated pre-transplant autoantibody positivity is not correlated to worse post-transplant outcomes in living liver donor transplants.
