https://www.ncbi.nlm.nih.gov/pubmed/30802337 Autoimmune hepatitis
Liver Int. 2019 Feb 25. doi: 10.1111/liv.14081. [Epub ahead of print]
Racial Disparities in Presentation and Outcomes of Pediatric Autoimmune Hepatitis.
Palle SK1,2, Naik KB1,3, McCracken CE2, Kolachala VL2, Romero R1,2, Gupta NA1,2.
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Abstract

BACKGROUND & AIMS:
Most studies on autoimmune hepatitis (AIH) in children are in predominantly Caucasian cohorts. Pediatric AIH in African-Americans (AA) is understudied, with a dearth of clinical predictors of outcome, often leading to serious complications and even mortality. The aim of the study was to define disease presentation, progression, response to therapy and outcomes in pediatric AIH in a well-defined, large, single center, demographically diverse population.

METHODS:
We conducted a review of patients with AIH who were followed at this tertiary liver transplant center. Clinical and laboratory covariates were assessed with regards to disease presentation, progression and outcomes in AA vs Non-AA children.

RESULTS:
AA patients constituted 42% of this cohort. At one-year follow-up, AA children were receiving significantly higher doses of steroids compared to non-AA. More AA presented with end stage liver disease (ESLD) with high IgG and GGT:platelet ratio. After adjusting for other risk factor variables like gender, age at presentation and ESLD, AA children were at 4.5 times higher risk for significant outcome liver transplant/death within the first 12 months of presentation. Post-transplant, recurrent AIH was seen in 50% of AA vs. 8% in non-AA.

CONCLUSIONS:
African American patients with AIH are more likely to present with ESLD and have an increased early risk for transplantation with high likelihood of disease recurrence post-transplantation. Studies are needed to delineate factors such as inherent biology, genetics and access to care. Early referral and tailored immunosuppressive regimens are required for AA patients with AIH.