Prednisone withdrawal advocates: Beware of recurrent autoimmune hepatitis

Abstract

Background. Recurrence of autoimmune hepatitis after liver transplantation is not rare, but there is little information about its time of onset, risk factors, response to treatment and prognosis. The aim of this study was to evaluate the rate of recurrence and outcome of autoimmune hepatitis after transplantation. Methods. The records of patients transplanted in eight centers in our country between 1984 and 1996 were retrospectively analyzed. Results. Forty-three of the 2331 (1.8%) recipients fulfilled diagnostic criteria of autoimmune hepatitis at the time of transplantation. Sixteen patients were excluded from evaluation. Nine (33%) of the 27 patients evaluated fulfilled criteria for recurrence of autoimmune hepatitis, with a mean time of recurrence after orthotopic liver transplantation of 2.6 ؎ 1.5 years. Patients with recurrence had a longer follow-up time after transplantation (5.1 vs. 2.5 years, P ‫؍‬ 0.0012) and were receiving less immunosuppressive treatment. The estimated risk of recurrence of autoimmune hepatitis in the graft increased over time: 8% over the first year and 68% 5 years after transplantation. None of the seven patients with liver-kidney microsomal-positive antibodies recurred (P ‫؍‬ 0.059). Fifty percent of the patients failed to respond or responded only partially to therapy, although none of the patients have deteriorated clinically after 2.4 ؎ 1.06 years of follow-up after recurrence. Conclusions. Recurrence of autoimmune hepatitis in the graft is a common event with an incidence that increases over time as immunosuppression is reduced. Although response to treatment is poor, patient and graft survival do not appear to be decreased.

Liver transplantation: Current status and novel approaches to liver replacement

“…72,73 It has also been recognized that autoimmune hepatitis recurs commonly after liver transplantation and that these patients should be maintained on somewhat higher levels of immunosuppression long-term, including maintenance prednisone to prevent recurrence. 72,74 …”