Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 27, 2021; 13(12): 2113-2127
Published online Dec 27, 2021. doi: 10.4254/wjh.v13.i12.2113
Use of oral vancomycin in children with autoimmune liver disease: A single centre experience
Angelo Di Giorgio, Anna Tulone, Emanuele Nicastro, Lorenzo Norsa, Aurelio Sonzogni, Lorenzo D'Antiga
Angelo Di Giorgio, Anna Tulone, Emanuele Nicastro, Lorenzo Norsa, Lorenzo D'Antiga, Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII , Bergamo 24127, Italy
Aurelio Sonzogni, Liver Pathology, Hospital Papa Giovanni XXIII, Bergamo 24127, Italy
Author contributions: Di Giorgio A, Tulone A drafted the paper; Di Giorgio A wrote the paper; Tulone A collected data; Nicastro E and Sonzogni A contributed to the conception analysis; Nicastro E, Norsa L, Sonzogni A, and D’Antiga L contributed to the interpretation of data; Norsa L performed the research; D’Antiga L supervised the study; and all authors approved the submission of this version of the manuscript and takes full responsibility for the manuscript contents.
Institutional review board statement: At our centre (tertiary referral centre for liver transplantation), no approval by local ethical committee is required for retrospective anonymised study which includes only patients from our centre.
Informed consent statement: The informed consent statement was waived.
Conflict-of-interest statement: There are no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Angelo Di Giorgio, MD, PhD, Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII , Piazza Oms 1, Bergamo 24127, Italy.
Received: May 27, 2021
Peer-review started: May 27, 2021
First decision: July 6, 2021
Revised: July 7, 2021
Accepted: November 25, 2021
Article in press: November 25, 2021
Published online: December 27, 2021
Research background

Pediatric autoimmune liver disease (AILD) includes autoimmune hepatitis (AIH) and autoimmune sclerosing cholangitis (ASC). Children with AILD not responding to standard immunosuppression (IS) may progress to end-stage liver disease and require liver transplantation.

Research motivation

Despite the absence of strong evidences the empirical use of candidate therapies has significantly increased in the last decades. Oral vancomycin has an immunomodulatory effect and it has been used in patients with primary sclerosing cholangitis. In pediatrics, the experience with oral vancomycin treatment (OVT) in patients with AIH or ASC is very limited.

Research objectives

In this study we evaluated: (1) The response to standard IS in a large cohort of pediatric patients with AILD; and (2) The efficacy of OVT to normalize transaminases (biochemical remission) and to achieve immunological remission in patients not responding to standard IS.

Research methods

Retrospective study of children diagnosed with AILD (AIH or ASC) at Hospital Papa Giovanni XXIII, Bergamo, Italy, in the last decade. Response to IS treatment and need for OVT was reported in all patients and compared between the two groups (AIH vs ASC).

Research results

Seventy-five patients diagnosed with AILD were included in this study (median age 10.5 years, range 5.6-13.4; F = 69%); 12 patients (16%, 10 with ASC) required OVT. Response to OVT was observed in 75% of patients and the percentage of those who achieved biochemical remission increased overall from 81% to 92%. Decrease in Sclerosing Cholangitis Outcomes in Pediatrics (SCOPE) index was reported in 42% of patients.

Research conclusions

This study shows that OVT may be considered as a valuable treatment option to achieve biochemical remission in children with AILD not responding to standard IS. Decrease in SCOPE index after OVT may suggest improvements in the long-term outcome.

Research perspectives

These promising preliminary results suggest that further prospective studies are needed to better define the efficacy of OVT in AILD.