Olivier Guillaud

CHU de Lyon - Groupement Hospitalier Edouard Herriot, Lyons, Rhône-Alpes, France

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Publications (65)145.14 Total impact

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    ABSTRACT: We sought to evaluate the frequency of cardiovascular risk factors in a cohort of patients 10 years after a liver transplant, and to assess their 10-year risk of fatal cardiovascular disease using Systematic COronary Risk Evaluation (SCORE) charts. Between January 1990 and June 1996, one hundred eighty-nine adults underwent a first liver transplant in our center. Fifty-nine patients (31%) died before reaching their tenth year, and 115 patients were available with complete clinical data at 10 years. The main indications for liver transplant were alcoholic (38%) and viral cirrhosis (40%). The median age of patients was 56 (range, 29-73 y), 80% were men, 23% were obese, 16% were active smokers, 18% were diabetic, 40% had hypercholesterolemia, and 77% had hypertension. Before the tenth year after transplant, 6 deaths were because of cardiovascular diseases, which represents the third cause of late death (> 1 year after liver transplant). After liver transplant, 5% of the surviving patients underwent ischemic cardiovascular events during the first decade. At a 10-year assessment, the median estimated 10-year risk of fatal cardiovascular disease was 1% (range, 0%-9%) and 10% of the patients had a high risk (ie, SCORE ≥ 5%). Our results suggest that the frequency of cardiovascular events is relatively low after a liver transplant, even if most of the patients had 1 or more cardiovascular risk factors. Nevertheless, clinicians should perform a similar evaluation 15 or 20 years after the liver transplant because cardiovascular risk exponentially increases with age.
    Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 02/2014; 12(1):55-61.
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    ABSTRACT: Long-lasting lifting is a key factor during endoscopic submucosal dissection (ESD) and can be obtained by water-jet injection of saline solution or by injection of viscous macromolecular solutions. Combination of the jet injection and the macromolecular viscous solutions has never been used yet. We assessed the ability of a new water-jet system to inject viscous solutions in direct viewing and in retroflexion. We compared jet injection of saline solution and hyaluronate 0.5 % to perform ESD on ex vivo pig stomachs in order to evaluate the benefits of macromolecular solutions when injected by a jet-injector system. This is a prospective comparative study in pig stomachs. Using the jet injector, four viscous solutions were tested: hydroxyethyl starch, glycerol mix, hyaluronate sodic (0.5 %), and poloxamer mix. Ten ESDs larger than 25 mm (five in direct viewing and five in retroflexion) and one larger than 10 cm were performed with each solution. ESD with hyaluronate jet injection was then compared with ESD with saline jet injection by performing 50 ESDs in each group. A single, minimally-experienced operator conducted all the procedures. All 145 resections were complete, including all marking points with two perforations. Eleven jet ESDs per solution were conducted without any injection issue. In the second part of the study, when compared with saline, significant benefit of hyaluronate was observed on dissection speed (0.80 vs. 1.08 cm(2)/min, p < 0.001). This is the first report on a jet-injector system allowing injection of macromolecular viscous solutions even with retroflexed endoscope. Jet injection of macromolecular solutions can speed up dissection in comparison with saline, and should now be tested on humans.
    Surgical Endoscopy 01/2014; · 3.43 Impact Factor
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    ABSTRACT: With small diameter endoscopes, transnasal esophagogastroduodenoscopy (t-EGD) is routinely performed. The aim of this prospective observational study was to evaluate the role of t-EGD for upper gastrointestinal bleeding (UGIB). One hundred and forty-five consecutive patients (mean age, 66±18.4 years) with suspicion of UGIB were classified a priori into 3 groups according to initial clinical presentation: (1) intensive care unit with EGD under sedation, (2) endoscopy unit with EGD under transient sedation and (3) unsedated t-EGD as "first look". Demographic, clinical and biological parameters, Rockall and Blatchford scores, endoscopic diagnosis and treatment, and outcome were analysed. Unsedated t-EGD was attempted in 89 patients, performed in 52 (5 failures, 28 contraindications) and the procedure was converted under sedation for 2 patients. Based on ASA classification, clinical (blood pressure, hemodynamical failure) and biological variables (hemoglobin, platelets, creatinine), these patients were less severe than in the other groups. Pre-endoscopic Rockall and Blatchford scores were significantly lower in this group. More patients in this group presented significant cardiovascular co-morbidity (47.2%), taking aspirin, clopidogrel and/or anticoagulant. Our results strongly support that "first look" unsedated t-EGD can avoid unnecessary sedation in selected patients with UGIB, presenting a low probability for endoscopic haemostatic treatment and high sedation risks.
    Gastroentérologie Clinique et Biologique 11/2013; · 0.80 Impact Factor
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    ABSTRACT: Liver transplantation (LT) is the therapeutic option for severe complications of Wilson's disease (WD). To report on the long-term outcome of WD patients following LT. The medical records of 121 French patients transplanted for WD between 1985 and 2009 were reviewed retrospectively. Seventy-five patients were adults (median age: 29 yrs, (18-66)) and 46 were children (median age: 14 yrs, (7-17)). The indication for LT was (1) fulminant/subfulminant hepatitis (n=64, 53%), median age = 16 yrs (7-53), (2) decompensated cirrhosis (n=50, 41%), median age = 31.5 yrs (12-66) or (3) severe neurological disease (n= 7, 6%), median age = 21.5 yrs (14.5-42). Median post-transplant follow-up was 72 months (0-23.5). Actuarial patient survival rates were 87% at 5, 10 and 15 years. Male gender, pre-transplant renal insufficiency, non elective procedure and neurological indication were significantly associated with poorer survival rate. None of these factors remained statistically significant under multivariate analysis, In patients transplanted for hepatic indications, the prognosis was poorer in case of fulminant or subfulminant course, non elective procedure, pre-transplant renal insufficiency and in patients transplanted before 2000. Multivariate analysis disclosed that only recent period of LT was associated with better prognosis. At last visit, the median calculated glomerular filtration rate was 93 mL/min (33-180); 11/93 patients (12%) had stage II renal insufficiency and none had stage III. Liver failure associated with WD is a rare indication for LT (<1%) which achieves an excellent long-term outcome, including renal function.
    Journal of Hepatology 11/2013; · 9.86 Impact Factor
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    ABSTRACT: Background and study aim: Endoscopic submucosal dissection (ESD) is recommended for en bloc R0 resection of superficial esophageal neoplasms larger than 20 mm, but is high risk and time-consuming. In the tunnel technique, incisions at the lower and upper lesion edges are joined by a submucosal tunnel and then lateral incisions are made. The mucosa is thereby easily separated from the muscular layer. We report our experience of esophageal tunnel ESD.Patients and methods: We retrospectively reviewed all consecutive esophageal tunnel ESDs performed at our unit between January 1 2010 and January 11 2013. Lesions were superficial esophageal neoplasms, UT1N0 at EUS. Results: 11 patients underwent tunnel ESD (nine squamous cell carcinomas, two adenocarcinomas). Mean dissected surface area was 13.25 cm². Mean procedure duration was 76.7 minutes. All 11 resections were en bloc and 9 /11 were R0. Complications were one subcutaneous emphysema with spontaneous resolution, and stenosis in 4 /11 patients (36.4 %) with resolution after 1 - 5 dilations.Conclusion: Tunnel ESD of superficial esophageal neoplasms is an interesting option, seeming to be faster and more effective than standard ESD, without higher morbidity.
    Endoscopy 10/2013; · 5.74 Impact Factor
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    ABSTRACT: In an era of organ scarcity, the use of left liver grafts for adult recipients could increase the access to liver transplantation (LT). The aim of this study was to evaluate the results in a single-center series of adult left LT over a 14-yr period. Between March 1996 and March 2010, 30 adult patients underwent LT with a left liver obtained from 16 split cadaveric livers and 14 living donors (LD). Portal vein inflow modulation was performed in selected cases. A total of 19 (63.3%) grafts had early dysfunction leading to graft failure in six cases (20%). One third of the grafts developed small-for-size syndrome (SFSS). One-yr patient and graft survival was 80% and 76.7%, respectively. Regarding two successive periods, one-yr patient and graft survival dramatically increased from 62.5% to 100% (p = 0.01) and 56.2% to 100% (p = 0.002), respectively. Multivariate analysis disclosed that completion of a portosystemic shunt and the occurrence of post-operative ascites were significantly associated with graft failure. Our results support that improved surgical techniques and careful patient selection can lead to a safe use of left livers for transplantation in adult recipients. Inflow modulation could be performed in very selected cases.
    Clinical Transplantation 06/2013; · 1.63 Impact Factor
  • Jérôme Dumortier, Olivier Guillaud, Olivier Boillot
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    ABSTRACT: After organ transplantation, strategies to simplify the therapeutic regimen may improve adherence and prevent acute organ rejection and/or late graft loss. The aim of the present study was to evaluate the safety and efficacy of conversion from a twice-daily to once-daily tacrolimus formulation in a large cohort of adult liver transplant (LT) patients. This retrospective observational single centre study included 394 LT patients with at least 6 months post-transplant follow-up, and no rejection episodes in the last three months. Conversion from a twice-daily to a once-daily formulation was based on a 1:1 proportion. Median age at the time of conversion was 53 yr (range: 18-72 yr); 66% were men. The main indication for liver transplant was alcoholic cirrhosis in 41%. Median conversion time after LT was 74 months (range: 6-218 months). Mean serum tacrolimus trough level decreased after conversion (pre-conversion level = 6.1±5.6 ng/mL vs. post-conversion level = 4.9±2.5 ng/mL, p < 0.05). After a mean follow-up of 24 months after conversion, 6 patients were converted to ciclosporine, 14 patients had stopped all calcineurine inhibitors, 16 patients had returned to twice-daily tacrolimus and 358 patients were still on one-daily tacrolimus. Acute rejection episode was observed in 7 patients. In conclusion, the results of our experience indicate that conversion from a twice-daily to a once-daily tacrolimus formulation is a safe and effective strategy in the management of stable liver transplant patients. © 2013 American Association for the Study of Liver Diseases.
    Liver Transplantation 03/2013; · 3.94 Impact Factor
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    ABSTRACT: Liver cirrhosis is a recognized risk factor for intrahepatic cholangiocarcinoma (I-CCa). Small I-CCa nodules might be undiagnosed or misdiagnosed as hepatocellular carcinoma (HCC) in the context of liver cirrhosis. The aim of this study was to determine the prevalence and clinical impact of undetected I-CCa in liver explants of adult cirrhotic patients undergoing liver transplantation (LT). From December 1985 to November 2008, a first LT was performed in 993 adult cirrhotic patients in three French academic Hospitals. All liver explants were analyzed for the presence of nodules. The diagnosis of HCC was made in 331 cases (33.3% of the patients). Similarly, an I-CCa was identified in 10 (1%) patients, with a mean size of 31 ± 17 mm. The mean age at transplantation was 58.8 yr (range 45 - 66), and all the patients were men. The mean follow-up after LT was 33 months (range 4-52). Post-transplant tumor recurrence was observed in five patients (50%), after a mean delay of 10 months. All five patients died. Malignant recurrence was associated with the presence of venous emboli on liver explants. Our results suggest that unrecognized I-CCa complicating liver cirrhosis is a rare entity, associated with high risk of recurrence and poor prognosis.
    Clinical Transplantation 02/2013; · 1.63 Impact Factor
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    ABSTRACT: INTRODUCTION: Chronic hepatitis C virus (HCV) infection is the most common chronic liver disease in patients with end stage renal disease (ESRD) and is well known as a frequent cause of mortality and graft loss among haemodialysed and kidney transplant patients. Up to now, there are no data on antiviral efficacy and tolerability of available protease inhibitors (telaprevir and boceprevir) in HCV infected haemodialysed patients. METHODS: We report 4 cases of HCV infected haemodialysed patients, who have not responded to a prior course of pegylated interferon (Peg-IFN) and ribavirin (RBV) and who were listed for kidney transplantation (KTx). These 4 patients received a second-line antiviral treatment with Peg-IFN, RBV and telaprevir. RESULTS: After 12 weeks of triple therapy, tolerability was acceptable and HCV-RNA became undetectable in 3/4 patients. Mild side-effects included anaemia leading to increasing the doses of erythropoietin (EPO). Dose of RBV ranged from 200mg three times a week to 200mg/day. CONCLUSION: Triple therapy with a first generation protease inhibitor could be the new standard for the treatment of HCV patients with ESRD. This needs to be confirmed by larger series.
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 11/2012; · 3.12 Impact Factor
  • Journal of Hepatology 07/2012; · 9.86 Impact Factor
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    ABSTRACT: The combination of ursodeoxycholic acid (UDCA) and vitamin E is a therapeutic option for nonalcoholic steatohepatitis (NASH) but randomized controlled studies have produced inconsistent results. The objective of this study was to report the long-term tolerability and efficacy of this combination in our ten-year single center experience. The study group included 101 adult patients with persistent elevation of serum aminotransferases (AST and ALT) and/or γ glutamyl-transferase (GGT), in whom a histological diagnosis of NASH was made from January 1998 to January 2009, and who were treated with a combination of UDCA with vitamin E. Median body mass index (30 kg/m(2)) remained unchanged during the study. UDCA and vitamin E were well tolerated (5% withdrawal for side effects). Mean serum AST, ALT and GGT levels (expressed as times of Upper Normal Limit) diminished significantly (1.39 ± 0.74 to 0.78 ± 0.34 for AST, 1.72 ± 0.92 to 0.91 ± 0.69 for AST and 3.25 ± 2.85 to 1.30 ± 1.30 for GGT). AST, ALT and GGT reached normal range in 80%, 70% and 65% of the patients, respectively. From the ten patients who had a second liver biopsy during follow-up, NAS score improved in seven, and worsened in one. The combination of UDCA with vitamin E significantly improves liver function tests in long-term and is very well tolerated.
    Gastroentérologie Clinique et Biologique 12/2011; 36(2):146-55. · 0.80 Impact Factor
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    ABSTRACT: Allocation of graft in liver transplantation (LT) depends mainly on Model for End Stage Liver Disease (MELD) score. We studied the prognostic ability of three metabolic liver function tests in 560 cirrhotic patients listed for transplantation, in comparison with MELD and Child-Turcotte-Pugh (CTP) scores. Indocyanine green retention rate (ICG), aminopyrine breath test (ABT), and galactose elimination capacity were performed at the time of listing in addition to standard biological parameters. Seventy-three patients died on waiting list, 438 were transplanted, and 73 died after LT. Cox regression analysis and receiver operating characteristic curves with c-statistics were calculated after stratification according to CTP and MELD score. For the mortality before transplantation, c-statistics showed that ICG and ABT had a slightly better prognostic ability (0.73 and 0.68, respectively) than MELD score (0.66), and similar to CTP score (0.70). ABT's prognostic ability remained significant once the MELD score (below and above 20) had already been taken into account. Only ICG had a prognostic ability to predict the survival after LT, even after stratification according to MELD and CTP score. Our results strongly support that ABT and ICG may be useful in the ranking of the patients in LT list, adding prognosis information in association with MELD score.
    Clinical Transplantation 12/2010; 25(5):755-65. · 1.63 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate the tolerability of the conversion from calcineurin inhibitor (CNI) to everolimus (ERL) in maintenance liver transplant (LT) recipients. From January 2005 to March 2008, ERL was introduced after LT as maintenance immunosuppressive therapy because of (i) de novo or recurrent cancer after LT, (ii) pre-existing liver carcinoma on the liver explant or (iii) CNI toxicity. CNI dosage was progressively reduced until discontinuation. The study population included 94 patients, of mean age 57 ± 10. The mean delay between LT and ERL introduction was 5 ± 5 yr. After a mean follow-up of 12 ± 7 months, 70% of the patients did present at least one side effect. The mean trough level of ERL was 6 μg/L at the end of follow-up. Main side effects included hyperlipidemia (37%), dermatitis (19%), mucositis (15%), and proteinuria (18%). Biopsy-proven acute rejection occurred in 9% of patients. Global ERL discontinuation rate was 21% (16% because of side effects). The results of our experience indicate that conversion to ERL is associated with adverse effects in 70% of patients leading to drug discontinuation in 16% (and amenable to dose reduction in the remainders). Longer follow-up periods are necessary to capture the impact of ERL fully on renal function and survival in cancer patients.
    Clinical Transplantation 12/2010; 25(4):660-9. · 1.63 Impact Factor
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    ABSTRACT: Transcatheter local thrombolytic therapy in patients with portosplanchnic venous thrombosis has been used in few cases. Here, we present our single-center experience with transcatheter thrombolytic therapy in three patients with extensive refractory portal and transjugular intrahepatic portosystemic shunt (TIPS) thrombosis. Thrombolytic therapy was successful for all three patients. Two patients developed minor procedure-related bleeding. Local thrombolysis could be proposed in case of TIPS thrombosis for patients in whom the venous flow cannot be restored by using conventional anticoagulant therapy and stent mechanical revision.
    Gastroentérologie Clinique et Biologique 10/2010; 34(12):721-5. · 1.14 Impact Factor
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    ABSTRACT: Mycophenolate mofetil (MMF) is a cornerstone immunosuppressive drug after liver transplantation (OLT). The aim of this study was to evaluate the long term results of the addition of MMF in maintenance OLT recipients. From 1996 to 2006, MMF was introduced because of (1) histologic features of rejection or (2) calcineurin inhibitor (CNI) toxicity in order to reduce CNI dosage. The study population included 208 patients (median, age 54 ± 9 years), with a median delay between OLT and MMF introduction of 54 ± 43 months. The median dosage of MMF was 1180 mg/d at the end of follow-up. After a median follow-up of 50 ± 26 months, 26.4% of the patients taking MMF did present ≥1 side effect and MMF discontinuation rate was 13.8% (transient in 3.8%). The main side effects were digestive disorders (45%), pruritus ± rash ± mucitis (12.7%), and myelosuppression (16.4%). MMF was withdrawn because of digestive disorders (17.2%), pruritus ± rash ± mucitis (17.2%), and myelosuppression (24.1%). The mean glomerular filtration rate as calculated by the Cockcroft-Gault formula value significantly increased after the introduction of MMF (58.1 vs 71.4 mL/min; paired t-test; P < .01). Improvement of renal function was significantly associated with initial association with tacrolimus (vs cyclosporine), initial trough level of cyclosporine (not tacrolimus), delay between OLT and MMF introduction, and age of renal impairment. Our results suggest that the introduction of MMF in OLT maintenance recipients is efficient and well-tolerated (one quarter of the patients presented significant side effects, leading to treatment discontinuation in 10% of the patients).
    Transplantation Proceedings 09/2010; 42(7):2602-6. · 0.95 Impact Factor
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    ABSTRACT: Tuberous sclerosis complex is a genetic multisystem disorder characterised by widespread hamartomas in several organs, including the brain, heart, skin, eyes, kidney, lung, and liver. Hepatic multiple, bilateral angiomyolipomas are a rare and usually asymptomatic complication in patients with tuberous sclerosis. We report here the case of a patient who needed liver transplantation because of debilitating manifestations and mechanical complications of massive liver involvement by multiple angiomyolipomas (severe malnutrition, anorexia and abdominal pain). Seventeen tumors, from 2 to 16 cm in diameter, were identified at examination of the liver explant. No feature suggestive of malignant behaviour was identified at histological examination. In conclusion, this unusual indication of liver transplantation underlines the interest of this therapeutic approach for benign tumors for which the multiplicity of the lesions and their huge volume prevent any attempt at surgical resection.
    Gastroentérologie Clinique et Biologique 09/2010; 34(8-9):494-8. · 1.14 Impact Factor
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    ABSTRACT: Abdominal trauma is a very rare cause of portal vein thrombosis. A 47-year-old woman presenting alcoholic cirrhosis was referred to our institution for refractory ascites. A transjugular intrahepatic portosystemic shunt (TIPS) was placed in October 2008 and the immediate post-operative course was uneventful. The efficiency of the TIPS was regularly checked by Doppler ultrasonography disclosing the complete regression of ascites and the patency of the stent. In February 2009, she was readmitted for recurrence of ascites. One week before admission, the patient reported a fall of a ladder with severe abdominal trauma and pain. The abdominal computed tomography scan showed thrombosis of the portal system extending from the spleno-mesenteric confluence to the portal vein. A mechanical revision of TIPS was realised, associated with local thrombolytic therapy. The clinical course was favourable and the efficiency of the TIPS was therefore regularly checked by Doppler ultrasonography disclosing the complete regression of ascites and the patency of the stent. Exhaustive search of an underlying thrombophilic state was performed to explain the occurrence of extensive portal thrombosis in our patient and identified a protein C deficiency. In conclusion, we report the first case of a patient who presented a TIPS and extensive portal and TIPS thrombosis probably because of an abdominal trauma. Biological screening identified an inherited protein C deficiency, which supports a recent notion that portal vein thrombosis most often occurs when both the local and the systemic aetiological factors are combined.
    European journal of gastroenterology & hepatology 07/2010; 22(7):883-5. · 1.66 Impact Factor
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    ABSTRACT: Fatty liver disease is a potential long-term complication of liver transplantation (LT). We therefore aimed to determine the prevalence and risk factors of liver steatosis in a large population of adult post-LT patients. We evaluated the clinical, biological, histological, and evolutive features of patients with a diagnosis of steatosis made at liver biopsy examination during post-LT follow-up. Risk factors were analyzed by univariate and multivariate analysis. In total, 1,596 liver biopsies from 599 patients were available. Recurrent liver disease was present in 178 patients. A histological diagnosis of steatosis was made in 131 (31.1%) of the remaining 421 patients (51.1% had normal liver tests): 53% had grade 1, 31% grade 2, and 16% grade 3 steatosis. Perisinusoidal fibrosis was present in 38 patients (29.0%). Histological lesions were consistent with the diagnosis of non-alcoholic steatohepatitis (NASH) in 5 patients (3.8%). At the end of follow-up, cirrhosis or extensive fibrosis was observed in 3 patients (2.25%). Multivariate analysis showed that seven factors (post-LT obesity, tacrolimus-based regimen, diabetes mellitus, hyperlipidemia, arterial hypertension, alcoholic cirrhosis as primary indication for LT, and pre-transplant liver graft steatosis) were risk factors for post-LT steatosis. When zero, one, two, three, four, five, and six factors were present, steatosis occurred in 6.0, 12.0, 22.1, 29.9, 65.5, 81.5, and 100.0%, respectively. Liver steatosis is a frequent late complication of LT; its development depends on a combination of host and graft factors. LT is therefore an interesting model to study the natural history and the determinants of liver steatosis.
    The American Journal of Gastroenterology 03/2010; 105(3):613-20. · 7.55 Impact Factor
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    ABSTRACT: Recently, noninvasive methods for the diagnosis of liver cirrhosis have been extensively developed. We assessed the accuracy of liver stiffness measurement, aspartate aminotransferase-to-platelet ratio index (APRI) score, 13C-aminopyrine breath test, and indocyanine green plasma clearance for the diagnosis of cirrhosis in patients with chronic liver disease and for the prediction of severe complications in cirrhotic patients. A total of 296 consecutive patients with chronic liver diseases of various causes were studied. Diagnostic accuracy was assessed by receiver operating characteristic curve analysis. Areas under the receiver operating characteristic curve for the diagnosis of cirrhosis were (95% confidence interval) 0.93 (0.90-0.96) for liver stiffness measurement, 0.82 (0.77-0.87) for 13C-aminopyrine breath test, and 0.81 (0.76-0.86) for APRI score. Using cutoff values of 14.1 kPa for liver stiffness, 4.15% dose/h for 13C-aminopyrine breath test, and 1 for APRI score, the positive predictive value was approximately 90% for the diagnosis of cirrhosis. Using cutoff values of 65.2 kPa for liver stiffness, 1.17% dose/h for 13C-aminopyrine breath test, 2.82 for APRI score, and 51.1% for indocyanine green plasma clearance, the positive predictive value was approximately 80% for the occurrence of severe complications among cirrhotic patients. Liver stiffness measurement, 13C-aminopyrine breath test, indocyanine green plasma clearance, and APRI score are reliable noninvasive methods for the diagnosis of cirrhosis in patients with chronic liver diseases of various causes, and are also prognostic indicators for the occurrence of severe complications in cirrhotic patients.
    European journal of gastroenterology & hepatology 02/2010; 22(5):532-40. · 1.66 Impact Factor
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    ABSTRACT: The combination of corticosteroids and azathioprine is the standard therapy for autoimmune hepatitis. The aim of this study was to describe our experience on long-term corticosteroid doses reducing and withdrawal in a large cohort of children with autoimmune hepatitis (AIH). All children presenting with AIH in our institution, from 1990 to 2006, were retrospectively included. The study population included 55 children [38 females, 17 males, median age 8 years (ranging from 0.8 to 15)] with type 1 (74.5%), type 2 (20%) or seronegative (5.5%) AIH. The diagnosis was made in 41 of them at the time of acute hepatitis (75%); the other 14 were diagnosed as chronic liver disease (25%). Treatment consisted of corticosteroids and azathioprine in 45 patients or corticosteroids alone in five patients. Complete remission was obtained within 1 year in 31 (69%) patients. The median initial dose of corticosteroids was 1.6 mg/kg/day, and the dose was progressively reduced to 0.32 mg/kg/day at 1 year, 0.24 mg/kg/day at 3 years, 0.11 mg/kg/day at 5 years and 0.05 mg/kg/day at 10 years. Corticosteroids withdrawal was possible in 0% of patients at 1 year, 75% at 3 years, 78% at 5 years and 90% at 10 years. At the end of follow-up, azathioprine was maintained in 36 patients (80%). Total treatment withdrawal was obtained in four patients. Our results strongly confirm that long-term corticosteroids withdrawal is possible in a large majority of children with autoimmune hepatitis.
    European journal of gastroenterology & hepatology 12/2009; 21(12):1413-8. · 1.66 Impact Factor

Publication Stats

296 Citations
145.14 Total Impact Points

Institutions

  • 2009–2013
    • CHU de Lyon - Groupement Hospitalier Edouard Herriot
      Lyons, Rhône-Alpes, France
  • 2007–2013
    • Hospices Civils de Lyon
      Lyons, Rhône-Alpes, France
    • Unité Inserm U1077
      Caen, Lower Normandy, France
    • University of Geneva
      • Division of Gastroenterology and Hepatology
      Genève, GE, Switzerland
  • 2006
    • CHU de Lyon - Hôpital Gériatrique des Charpennes
      Lyons, Rhône-Alpes, France
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France