‘De novo’ and ‘recurrent’ autoimmune hepatitis after liver transplantation: A comprehensive review

Kerkar, Nanda; Yanni, George

doi:10.1016/j.jaut.2015.08.017

Cited by 75 publications

(65 citation statements)

References 93 publications

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“…1,2 This condition, which affects mainly women, is characterized biochemically by increased aspartate and alanine aminotransferase (AST, ALT) levels, histologically by interface hepatitis and plasma cell infiltrates, and serologically by non-organ specific autoantibodies and increased immunoglobulin G (IgG). 3,4 Approximately 2-3% of liver transplants performed on children and 4-6% of liver transplants performed on adults in Europe and the United States are for AIH. 5 …”

Section: Recurrent and De Novo Autoimmune Hepatitis After Liver Transmentioning

confidence: 99%

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Autoimmune Hepatitis in the Liver Transplant Graft

Beal

Black

Michaels

2017

Clinics in Liver Disease

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SYNOPSIS Recurrent autoimmune hepatitis and de novo autoimmune hepatitis are two important causes of late graft failure after liver transplantation. Recurrent autoimmune hepatitis occurs in patients who undergo liver transplantation for autoimmune hepatitis. De novo autoimmune hepatitis occurs in patients who are transplanted for etiologies other than autoimmune hepatitis. Although typically treated with standard treatment for autoimmune hepatitis including corticosteroids and azathioprine, both recurrent and de novo autoimmune hepatitis may progress to end-stage liver disease requiring re-transplant.

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Section: Recurrent and De Novo Autoimmune Hepatitis After Liver Transmentioning

confidence: 99%

“…4 Biochemical signs of recurrence include elevated ALT and AST. 4 Most patients with recurrent AIH have positive autoantibodies, although several studies have demonstrated that patients who undergo LT for AIH have persistent autoantibodies, but at lower titers than prior to LT. 26 …”

Section: Recurrent Autoimmune Hepatitis After Liver Transplantmentioning

confidence: 99%

Autoimmune Hepatitis in the Liver Transplant Graft

Beal

Black

Michaels

2017

Clinics in Liver Disease

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“…Few non‐AIH patients (6–10%) have serological and histological presentations that are similar to AIH after LT, which is known as de novo AIH . There are quite a few reports on adulthood de novo AIH onset after HCV infection treated by interferon and ribavirin following LT in patients with HCV‐related cirrhosis; however, the diagnosis of de novo AIH is very difficult …”

Section: Treatmentmentioning

confidence: 99%

Chinese consensus on the diagnosis and management of autoimmune hepatitis (2015)

2017

J of Digest Diseases

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“…Further, AIH in the graft can occur de novo, that is, after LT for nonautoimmune liver disorders 2,60 confounding the true recurrence rate. Some have chosen to give other names like “graft dysfunction mimicking AIH” and “plasma cell hepatitis.” 61 We have summarized reported long-term outcomes of LT recipients with autoimmune liver diseases from other studies in Table 9.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Liver Transplant Recipients With Autoimmune Liver Disease Using Long-Term Dual Immunosuppression Regimen Without Corticosteroid

Jones

Vanatta

Kamal

et al. 2017

Transplantation Direct

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BackgroundLiver transplant (LT) recipients with autoimmune liver disease (primary sclerosing cholangitis, primary biliary cholangitis, autoimmune hepatitis) are at increased risk of developing acute cellular rejection (ACR), and in many cases graft failure due to recurrent disease. We describe our experience with dual immunosuppression without steroid maintenance and analyze its effect on disease recurrence; ACR; patient and graft survivals; and complications, such as sepsis and de novo malignancy.MethodsWe included 74 consecutive LT recipients (April 2006 to April 2013) with autoimmune liver disease (primary sclerosing cholangitis, 20; primary biliary cholangitis, 23; autoimmune hepatitis, 31) from a single transplant center. Immunosuppression protocol included rabbit antithymocyte globulin for induction and mycophenolate mofetil with tacrolimus or sirolimus/everolimus indefinitely for maintenance.ResultsOverall 1-, 3-, 5-, and 7-year patient survival was 95.9%, 90.4%, 82,2% and 74.9%, re–graft-free survival was 93.2%, 86.3%, 79.9%, and 72.8%, respectively (median follow-up, 5.5 years). In a multivariate Cox regression analysis, sepsis during post-LT period (P = 0.040; hazard ratio [HR], 2.52; 95% confidence interval [CI], 1.04-6.11), steroid use for ACR (P = 0.037; HR, 2.60; 95% CI, 1.06-6.34), and younger age (<40 years) at LT (P = 0.038; HR, 2.53; 95% CI, 1.05-6.10) predicted graft survival, whereas steroid use for ACR was the only variable that was predictive of overall patient survival (P = 0.004; HR, 4.10; 95% CI, 1.59-10.52). Overall, 34 biopsy-proven ACR was noted in 22 LT recipients (30%), 13 (17.5%) had disease recurrence, and 34 episodes of sepsis occurred in 19 patients.ConclusionsDual immunosuppression protocol in LT recipients with autoimmune liver disease without corticosteroid maintenance had acceptable rates of survival and ACR without predisposing patients to the adverse effects of long-term steroid therapy.

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‘De novo’ and ‘recurrent’ autoimmune hepatitis after liver transplantation: A comprehensive review

Cited by 75 publications

References 93 publications

Autoimmune Hepatitis in the Liver Transplant Graft

Autoimmune Hepatitis in the Liver Transplant Graft

Chinese consensus on the diagnosis and management of autoimmune hepatitis (2015)

Outcomes of Liver Transplant Recipients With Autoimmune Liver Disease Using Long-Term Dual Immunosuppression Regimen Without Corticosteroid

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