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Clinical significance of HLA DRB1*03–DRB1*04 in type 1 autoimmune hepatitis

Authors


  • Dr. Aldo J. Montano-Loza is the recipient of an international training grant from the American College of Gastroenterology.

Albert J. Czaja, MD, Mayo Clinic, 200 First Street S.W. Rochester, MN 55905, USA.
Tel: +50 7 284 8118
Fax: 50 7 284 0538
e-mail: czaja.albert@mayo.edu

Abstract

Abstract: Background: HLA DRB1*03–DRB1*04 combines both susceptibility factors for type-1 autoimmune hepatitis.

Aims: Determine whether this phenotype is a risk factor for autoimmune hepatitis in white North American patients, assess its associations with clinical features and treatment outcome, and determine whether alleles within this phenotype affect prognosis.

Methods: One hundred and ninety-eight patients with type 1 autoimmune hepatitis and 102 normal adults were evaluated. HLA typing was performed by DNA-based techniques.

Results: Twenty-eight patients had HLA DRB1*03–DRB1*04, and the frequency was higher than in normal subjects (14% vs 4%, OR 4.0%, 95% CI 1.4–11.8, P=0.01). Patients with DRB1*03–DRB1*04 relapsed less frequently than patients with DRB1*03 (1.3±0.3 vs 2.1±0.2, P=0.04), but they otherwise had outcomes similar to patients with other phenotypes. Patients with DRB1*03-DRB1*04 who had 3–4 alleles encoding lysine at position DRβ71 within the class II molecule of the major histocompatibility complex developed cirrhosis more commonly (75% vs 9%, P=0.05) and had a higher frequency of hepatic-related death or liver transplantation (40% vs 0%, P=0.04) than patients with fewer alleles.

Conclusions: HLA DRB1*03–DRB1*04 is a risk factor for type-1 autoimmune hepatitis, and its impact on outcome relates to the diversity of DRB1*04 alleles that encode a critical motif.

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