Disease recurrence after liver transplantation in Western Australia

Yusoff, Ian F.; House, A. K.; Boer, W. Bastiaan de; Ferguson, John; Garas, George; Heath, Dugal; Mitchell, Andrew; Jeffrey, Gary P.

doi:10.1046/j.1440-1746.2002.02632.x

Cited by 43 publications

(38 citation statements)

References 20 publications

(27 reference statements)

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“…In issue 2 of the Journal, Yusoff et al provide further evidence that recurrence of all three diseases is relatively common, but argue that it has little impact on transplant outcomes. 1 The frequency and clinical importance of recurrence of these diseases reported in other studies vary considerably. 2 This is not surprising, given that the histological appearance of recurrent primary biliary cirrhosis and autoimmune hepatitis can be difficult to differentiate from those of graft rejection.…”

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confidence: 97%

“…Thus, it seems that recurrence of primary biliary cirrhosis after transplantation does occur, but appears to exert little serious effect on organ function. 1,5 However, in the non-transplant setting, primary biliary cirrhosis is a disease that evolves over decades, and much longer follow up of patients with recurrent primary biliary cirrhosis is clearly required to determine with certainty whether the natural history of the disease is altered after transplantation.…”

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confidence: 99%

“…1 It has long been recognized that in patients transplanted for hepatitis B-or C-related liver disease, recurrence of hepatitis infection in the graft is common and that this may result in serious and progressive liver injury. There are now varying levels of evidence to suggest that most other forms of chronic liver disease also have the potential to recur in the graft, with the only clear exceptions being metabolic diseases primarily confined to the liver; such as Wilson's disease and a1-anti-trypsin deficiency.…”

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confidence: 99%

“…[7][8][9] Yusoff et al found evidence of recurrent autoimmune hepatitis in two of 12 patients, although it was not clear if either patient had developed significant fibrosis in their graft. 1 However, other series have now clearly documented the potential for rapid progression to cirrhosis in patients with recurrent autoimmune hepatitis, and that these patients require long-term maintenance steroid-based immunosuppression to prevent disease progression. 7,8 Currently, approximately 15% of all liver transplants performed in Australasia are undertaken for end-stage alcoholic liver disease.…”

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confidence: 99%

“…The recent study by Yusoff et al does not include data on recurrent hepatitis C and the number of patients transplanted for hepatitis B is very small. 1 However, it is clear that on a worldwide basis, these two diseases, and associated hepatocellular cancer, are now responsible for the largest burden of post-transplant morbidity and mortality due to disease recurrence.…”

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confidence: 99%

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Disease recurrence after liver transplantation: Need we worry?

Gow

Angus

2002

J of Gastro and Hepatol

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confidence: 97%

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confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

mentioning

confidence: 99%

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Disease recurrence after liver transplantation: Need we worry?

Gow

Angus

2002

J of Gastro and Hepatol

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Differential priming of CD8 and CD4 T-cells in animal models of autoimmune hepatitis and cholangitis

et al. 2007

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The pathogenesis of autoimmune liver diseases is poorly understood. Animal models are necessary to investigate antigen presentation and priming of T-cells in the context of autoimmunity in the liver. Transgenic mouse models were generated in which the model antigen ovalbumin is expressed in hepatocytes (TF-OVA) or cholangiocytes (ASBT-OVA). A utoimmune hepatitis and cholangitis are triggered by autoreactive T-cells. Animal models are needed to study the early events in their pathogenesis, namely, the priming of autoreactive T-cells. The requirements for an immune-based animal model are restriction of the immune response to the liver, antigen specificity, and the potential to study the priming of CD8 and CD4 T-cells. Several animal models of autoimmune hepatitis have been developed, 1 none of which fulfills these criteria. Transgenic expression of foreign major histocompatibility complex (MHC) class I molecules in the liver has been widely used. [2][3][4] However, this model has a significant disadvantage: unlike the pathophysiology of an immune or autoimmune reaction, CD8 T cells recognize their antigen on hepatocytes but the antigen is not presented by professional antigen-presenting cells (APCs) in this model. Injection of the synthetic peptide ova p257-264 (SIINFEKL) into mice followed by transfer of antigenspecific CD8 T-cells has also been used, 5 but the possibility of peptide binding to MHC-I molecules on T-cells themselves and their activation by each other 6 or by unrelated cells is a possible concern. Infection with virus expressing ovalbumin 7 results in temporary expression of ovalbumin but also activation of innate immune mechanisms. No animal model exists that allows the simulta-

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Recurrent primary sclerosing cholangitis after liver transplantation: A magnetic resonance cholangiography study with analyses of predictive factors

et al. 2005

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Primary sclerosing cholangitis (PSC) is a well-established indication for orthotopic liver transplantation (OLT), but post-OLT bile duct strictures complicate the outcome for these patients. These strictures might represent recurrent PSC (rPSC). To estimate the risk factors for post-OLT non-anastomotic bile duct strictures in PSC patients and to find their possible etiology, we performed magnetic resonance cholangiography (MRC) and angiography (MRA) in all PSC patients who had undergone OLT and were alive (median follow-up 6.4 years, range 1.4-15.2 years). This group of PSC patients was compared to a group of 45 non-PSC patients who had also undergone OLT. A logistic regression analysis was performed to find predictors of rPSC. Bile duct strictures were found in 19/49 PSC patients and in 4/45 non-PSC patients (P ‫؍‬ 0.001). In the PSC group nine patients without other possible explanations for bile duct strictures than rPSC were identified, i.e., the estimated risk of rPSC was 9/49 (18%); surprisingly similar changes were also seen in one patient without a pre-transplant PSC diagnosis. Severe liver disease due to rPSC was seen in 4/9 patients (one patient died and three are being evaluated for re-OLT). Steroid-resistant rejection was the only significant predictor for rPSC. In conclusion, our study shows that by the use of MRC we found more bile duct strictures in PSC patients post-OLT compared to controls and that steroidresistant rejections was a predictor of such changes. (Liver Transpl 2005;11:1361-1369.)

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Disease recurrence after liver transplantation in Western Australia

Abstract: Disease recurrence after OLT does occur, but overall, it is relatively uncommon. Recurrence rates vary significantly and depend, in part, on indication for OLT. With medium-term follow up, recurrent disease does not have an effect on mortality.

Cited by 43 publications

References 20 publications

Disease recurrence after liver transplantation: Need we worry?

Disease recurrence after liver transplantation: Need we worry?

Differential priming of CD8 and CD4 T-cells in animal models of autoimmune hepatitis and cholangitis

Recurrent primary sclerosing cholangitis after liver transplantation: A magnetic resonance cholangiography study with analyses of predictive factors

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