RISING INCIDENCE OF PAEDIATRIC AUTOIMMUNE LIVER DISEASE - ? AN IMMUNE MEDIATED POSTCOVID- 19 PHENOMENON.

Warner, S.; Mtegha, M.; Prakash, K.J.; Karthikeyan, P.; North-Lewis, P.; Rajwal, S.

RISING INCIDENCE OF PAEDIATRIC AUTOIMMUNE LIVER DISEASE - ? AN IMMUNE MEDIATED POSTCOVID- 19 PHENOMENON.

All Authors

Warner, S.

Mtegha, M.

Prakash, K.J.

Karthikeyan, P.

North-Lewis, P.

Rajwal, S.

LTHT Author

Warner, Suzan
Mtegha, Marumbo
Jayaprakash, Kavitha
Karthikeyan, Palaniswamy
North-Lewis, Penny
Rajwal, Sanjay

LTHT Department

Leeds Children's Hospital
Children's Services
Children's Liver Unit
Medicines Management & Pharmacy Services
Clinical Pharmacy

Non Medic

Paediatric Liver Pharmacist

Publication Date

2025

Item Type

Conference Abstract

Abstract

Higher incidences of type 1 diabetes and coeliac disease are increasingly reported compared to pre-COVID-19 pandemic levels.1 2 Moreover, higher rates of severe diabetic ketoacidosis are seen in children with newly diagnosed diabetes.1 3 The incidence and disease severity of paediatric autoimmune liver disease (AILD) between pre and post-COVID-19 pandemic levels has not been assessed. Retrospective data from a cohort of 202 children with newly diagnosed AILD over a 10 year period between 2015 to 2024 was reviewed from a UK quaternary liver specialist centre. Findings show a higher incidence of autoimmune hepatitis type 1 (AIH-1), Primary sclerosing cholangitis (PSC) and Overlap/ Autoimmune sclerosing cholangitis (ASC) in the post- COVID-19 time period (2020-2024) compared to pre-COVID (2015-2019), with the greatest increase observed in the AIH-1 cohort (p<0.0001) (figure 1). A higher age-range for all three subgroups was seen but most notably in AIH-1 (p=0.0093). In contrast, minimal variation for incidence and age-range was observed in AIH-2 patients. The INR was higher in AIH-2 patients compared to pre-pandemic levels (p=0.0198). A greater proportion of patients presenting with decompensated liver disease was observed in all subgroups post-COVID- 19 but was most marked in Overlap/ASC children (p=0.0313). Next the development of IBD (#1 year of AILD diagnosis) was assessed; higher rates of new-IBD was observed in PSC patients post-COVID-19 (p<0.0001), specifically for Crohn's disease (p=0.0030) and indeterminate colitis (p<0.0001). Patient demographics were interrogated to identify possible associated factors; a significant rise in the incidence of African patients presenting with AIH-2 (p=0.0011) and Overlap/ASC (p=0.0043) was observed post-COVID-19. The rate of concomitant viral infections including COVID-19 was low in all subgroups; no patients experienced severe COVID-19 or PIMS-TS. In conclusion, our study is the first to describe a higher incidence of children presenting with newly diagnosed AILD in the post vs. pre-COVID-19 pandemic era. Importantly, children presented older, had a higher rate of decompensated liver disease and patients with PSC were more likely to develop concomitant IBD. The higher incidence and disease severity observed in our AILD cohort and that reported in the literature for other autoimmune conditions1-3 maybe a post-COVID-19 pandemic phenomenon resulting in an abnormal immune-response in susceptible individuals following on from long-periods of social isolation and the lifting of COVID lock-down measures. Line graph displaying incidence of AIH-1 - the dotted line splits the graph into pre-COVID-19 (2015-2019) and post- COVID-19 (2020-2024) time periods. The incidence of AIH-1 rises sharply from 2020 and peaks at 2021 prior to decreasing to an incidence level which remains above pre- COVID-19 baseline levels.