Liver transplantation for autoimmune hepatitis: Pre‐transplant does not predict the early post‐transplant outcome

Abstract

Background and Aims: Autoimmune hepatitis (AIH) is a rare indication (<5%) for liver transplantation (LT). The aim of this study was to describe the early outcome after LT for AIH. Methods:A multicenter retrospective nationwide study including all patients aged ≥16 transplanted for AIH in France was conducted. Occurrences of biliary and vascular complications, rejection, sepsis, retransplantation and death were collected during the first year after LT.Results: A total of 344 patients (78.8% of women, 17.0% of (sub)fulminant hepatitis and 19.2% of chronic liver diseases transplanted in the context of acute-on-chronic liver failure [ACLF]) were included, with a median age at LT of 43.6 years. Acute rejection, sepsis, biliary and vascular complications occurred in respectively 23.5%, 44.2%, 25.3% and 17.4% of patients during the first year after LT. One-year graft and patient survivals were 84.3% and 88.0% respectively. The main cause of early death was sepsis. Pre-LT immunosuppression was not associated with an increased risk for early infections or surgical complications. Significant risk factors for septic events were LT

Autoimmune hepatitis recurrence after liver transplantation: “Les jeux sont faits”

“…If the earliest rAIH was observed at 3.1 months in our cohort, the median time from LT to recurrence was 53.6 months and is consistent with existing literature, reporting times to recurrence ranging from 4 to 55 months 8,17 . Of note, rAIH has little impact on patient survival after LT 9,18 …”

“…If the earliest rAIH was observed at 3.1 months in our cohort, the median time from LT to recurrence was 53.6 months and is consistent with existing literature, reporting times to recurrence ranging from 4 to 55 months. [8,17] Of note, rAIH has little impact on patient survival after LT. [9,18] Previous reports identified several risk factors for rAIH, but the results of these studies are highly conflicting (summarized in Table 4). Prados et al [5] suggested that the presence of anti-LKM1 could be a protective factor for rAIH, whereas another study demonstrated that autoantibody titers before LT do not correlate with disease activity and prognosis.…”