Celiac disease autoantibodies in severe autoimmune liver disease and the effect of liver transplantation

Alberto Rubio-Tapia, Ahmad S. Abdulkarim, Russell H. Wiesner, S. Breanndan Moore, Patricia K. Krause, Joseph A Murray

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background/aims: Celiac disease (CD) is associated with primary biliary cirrhosis, primary sclerosing cholangitis and autoimmune hepatitis. We investigated the following: (i) the prevalence of tissue transglutaminase antibodies (tTGAs) and endomysial antibodies (EMAs) in end-stage autoimmune liver disease (ESALD), (ii) the correlation among auto-antibodies and the human leucocyte antigen (HLA) haplotype, and (iii) the effect of liver transplantation on antibody kinetics. Methods: Pretransplantation sera from 488 patients (310 with ESALD, and 178 with non-autoimmune disease) were tested for tTGAs. Positive samples were also tested for EMAs, and retested 6-12 and ≥24 months post-transplantation. Results were correlated with the HLA type of the recipient. Results: Serological evidence of CD was found in 3% (ESALD) vs. 0.6% (non-autoimmune) of the patients (five-fold increased risk in ESALD). The prevalence of tTGAs (14.2 vs. 5.4%, P = 0.0001) and EMAs (4.3 vs. 0.78%, P = 0.01) was significantly higher in patients with the HLA-DQ2 or HLA-DQ8 haplotypes. tTGAs and EMAs normalized in 94 and 100%, respectively, without gluten exclusion post-transplantation. Post-transplantation, of the five patients with symptoms of 'classical' CD, three improved. Intestinal lymphoma was diagnosed in another two cases with clinically 'silent' CD. Conclusions: Patients with ESALD, especially those who are HLA-DQ2 or HLA-DQ8 positive had a high prevalence of CD-associated antibodies. Both tTGAs and EMAs decreased post-transplantation without gluten withdrawal. Immunosuppression may improve symptoms of CD, but might not prevent progression to intestinal lymphoma.

Original languageEnglish (US)
Pages (from-to)467-476
Number of pages10
JournalLiver International
Volume28
Issue number4
DOIs
StatePublished - Apr 2008

Fingerprint

Celiac Disease
Liver Transplantation
Autoantibodies
Autoimmune Diseases
Liver Diseases
Antibodies
HLA Antigens
End Stage Liver Disease
Transplantation
Glutens
Haplotypes
Lymphoma
Autoimmune Hepatitis
Sclerosing Cholangitis
Biliary Liver Cirrhosis
Immunosuppression
transglutaminase 2

Keywords

  • Autoimmune hepatitis
  • Primary biliary cirrhosis
  • Primary sclerosing cholangitis
  • Serology

ASJC Scopus subject areas

  • Hepatology

Cite this

Celiac disease autoantibodies in severe autoimmune liver disease and the effect of liver transplantation. / Rubio-Tapia, Alberto; Abdulkarim, Ahmad S.; Wiesner, Russell H.; Moore, S. Breanndan; Krause, Patricia K.; Murray, Joseph A.

In: Liver International, Vol. 28, No. 4, 04.2008, p. 467-476.

Research output: Contribution to journalArticle

Rubio-Tapia, Alberto ; Abdulkarim, Ahmad S. ; Wiesner, Russell H. ; Moore, S. Breanndan ; Krause, Patricia K. ; Murray, Joseph A. / Celiac disease autoantibodies in severe autoimmune liver disease and the effect of liver transplantation. In: Liver International. 2008 ; Vol. 28, No. 4. pp. 467-476.
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abstract = "Background/aims: Celiac disease (CD) is associated with primary biliary cirrhosis, primary sclerosing cholangitis and autoimmune hepatitis. We investigated the following: (i) the prevalence of tissue transglutaminase antibodies (tTGAs) and endomysial antibodies (EMAs) in end-stage autoimmune liver disease (ESALD), (ii) the correlation among auto-antibodies and the human leucocyte antigen (HLA) haplotype, and (iii) the effect of liver transplantation on antibody kinetics. Methods: Pretransplantation sera from 488 patients (310 with ESALD, and 178 with non-autoimmune disease) were tested for tTGAs. Positive samples were also tested for EMAs, and retested 6-12 and ≥24 months post-transplantation. Results were correlated with the HLA type of the recipient. Results: Serological evidence of CD was found in 3{\%} (ESALD) vs. 0.6{\%} (non-autoimmune) of the patients (five-fold increased risk in ESALD). The prevalence of tTGAs (14.2 vs. 5.4{\%}, P = 0.0001) and EMAs (4.3 vs. 0.78{\%}, P = 0.01) was significantly higher in patients with the HLA-DQ2 or HLA-DQ8 haplotypes. tTGAs and EMAs normalized in 94 and 100{\%}, respectively, without gluten exclusion post-transplantation. Post-transplantation, of the five patients with symptoms of 'classical' CD, three improved. Intestinal lymphoma was diagnosed in another two cases with clinically 'silent' CD. Conclusions: Patients with ESALD, especially those who are HLA-DQ2 or HLA-DQ8 positive had a high prevalence of CD-associated antibodies. Both tTGAs and EMAs decreased post-transplantation without gluten withdrawal. Immunosuppression may improve symptoms of CD, but might not prevent progression to intestinal lymphoma.",
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T1 - Celiac disease autoantibodies in severe autoimmune liver disease and the effect of liver transplantation

AU - Rubio-Tapia, Alberto

AU - Abdulkarim, Ahmad S.

AU - Wiesner, Russell H.

AU - Moore, S. Breanndan

AU - Krause, Patricia K.

AU - Murray, Joseph A

PY - 2008/4

Y1 - 2008/4

N2 - Background/aims: Celiac disease (CD) is associated with primary biliary cirrhosis, primary sclerosing cholangitis and autoimmune hepatitis. We investigated the following: (i) the prevalence of tissue transglutaminase antibodies (tTGAs) and endomysial antibodies (EMAs) in end-stage autoimmune liver disease (ESALD), (ii) the correlation among auto-antibodies and the human leucocyte antigen (HLA) haplotype, and (iii) the effect of liver transplantation on antibody kinetics. Methods: Pretransplantation sera from 488 patients (310 with ESALD, and 178 with non-autoimmune disease) were tested for tTGAs. Positive samples were also tested for EMAs, and retested 6-12 and ≥24 months post-transplantation. Results were correlated with the HLA type of the recipient. Results: Serological evidence of CD was found in 3% (ESALD) vs. 0.6% (non-autoimmune) of the patients (five-fold increased risk in ESALD). The prevalence of tTGAs (14.2 vs. 5.4%, P = 0.0001) and EMAs (4.3 vs. 0.78%, P = 0.01) was significantly higher in patients with the HLA-DQ2 or HLA-DQ8 haplotypes. tTGAs and EMAs normalized in 94 and 100%, respectively, without gluten exclusion post-transplantation. Post-transplantation, of the five patients with symptoms of 'classical' CD, three improved. Intestinal lymphoma was diagnosed in another two cases with clinically 'silent' CD. Conclusions: Patients with ESALD, especially those who are HLA-DQ2 or HLA-DQ8 positive had a high prevalence of CD-associated antibodies. Both tTGAs and EMAs decreased post-transplantation without gluten withdrawal. Immunosuppression may improve symptoms of CD, but might not prevent progression to intestinal lymphoma.

AB - Background/aims: Celiac disease (CD) is associated with primary biliary cirrhosis, primary sclerosing cholangitis and autoimmune hepatitis. We investigated the following: (i) the prevalence of tissue transglutaminase antibodies (tTGAs) and endomysial antibodies (EMAs) in end-stage autoimmune liver disease (ESALD), (ii) the correlation among auto-antibodies and the human leucocyte antigen (HLA) haplotype, and (iii) the effect of liver transplantation on antibody kinetics. Methods: Pretransplantation sera from 488 patients (310 with ESALD, and 178 with non-autoimmune disease) were tested for tTGAs. Positive samples were also tested for EMAs, and retested 6-12 and ≥24 months post-transplantation. Results were correlated with the HLA type of the recipient. Results: Serological evidence of CD was found in 3% (ESALD) vs. 0.6% (non-autoimmune) of the patients (five-fold increased risk in ESALD). The prevalence of tTGAs (14.2 vs. 5.4%, P = 0.0001) and EMAs (4.3 vs. 0.78%, P = 0.01) was significantly higher in patients with the HLA-DQ2 or HLA-DQ8 haplotypes. tTGAs and EMAs normalized in 94 and 100%, respectively, without gluten exclusion post-transplantation. Post-transplantation, of the five patients with symptoms of 'classical' CD, three improved. Intestinal lymphoma was diagnosed in another two cases with clinically 'silent' CD. Conclusions: Patients with ESALD, especially those who are HLA-DQ2 or HLA-DQ8 positive had a high prevalence of CD-associated antibodies. Both tTGAs and EMAs decreased post-transplantation without gluten withdrawal. Immunosuppression may improve symptoms of CD, but might not prevent progression to intestinal lymphoma.

KW - Autoimmune hepatitis

KW - Primary biliary cirrhosis

KW - Primary sclerosing cholangitis

KW - Serology

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