Recurrence of Autoimmune Chronic Active Hepatitis Following Orthotopic Liver Grafting

Neuberger, James; Portmann, Bernard; Calne, R. Y.; Williams, Roger

doi:10.1097/00007890-198404000-00009

Cited by 156 publications

(99 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Recurrent PBC findings are nearly identical to those seen in native livers. 80,81 The pathognomonic lesion is noninfectious granulomatous cholangitis in the proper setting, which includes presence of antimitochondrial antibodies and absence of other causes such as infections and biliary strictures. Diagnostic lesions are not always present.…”

Section: Recurrent Diseases and New-onset Diseasesmentioning

confidence: 99%

Liver biopsy interpretation for causes of late liver allograft dysfunction

2006

View full text Add to dashboard Cite

Evaluation of needle biopsies and extensive clinicopathological correlation play an important role in the determination of liver allograft dysfunction occurring more than 1 year after transplantation. Interpretation of these biopsies can be quite difficult because of the high incidence of recurrent diseases that show histopathological, clinical, and serological features that overlap with each other and with rejection. Also, more than one insult can contribute to allograft injury. In an attempt to enable centers to compare and pool results, improve therapy, and better understand pathophysiological disease mechanisms, the Banff Working Group on Liver Allograft Pathology herein proposes a set of consensus criteria for the most common and problematic causes of late liver allograft dysfunction, including late-onset acute and chronic rejection, recurrent and new-onset viral and autoimmune hepatitis, biliary strictures, and recurrent primary biliary cirrhosis and primary sclerosing cholangitis. A discussion of differential diagnosis is also presented. (HEPATOLOGY 2006;44:489-501.)

show abstract

Section: Recurrent Diseases and New-onset Diseasesmentioning

confidence: 99%

Liver biopsy interpretation for causes of late liver allograft dysfunction

2006

View full text Add to dashboard Cite

show abstract

“…In 1984, Neuberger et al 1 described the first case of recurrent AIH after OLT in which the recurrence of disease, based on elevated liver enzyme levels and liver biopsy findings compatible with AIH, coincided with a significant reduction in corticosteroid dosage as part of the immunosuppressive regimen. In this patient an increase in immunosuppressive therapy led to normalization of liver tests.…”

Section: Commentsmentioning

confidence: 99%

Prednisone withdrawal advocates: Beware of recurrent autoimmune hepatitis

Davila

Keeffe

1999

Hepatology

View full text Add to dashboard Cite

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.

show abstract

“…3,4 Furthermore, autoantibodies and hypergammaglobulinemia disappear in most patients within 2 years. 1,2 Despite these successes, recurrent disease is possible, 2,3,[5][6][7][8][9][10][11][12][13] and recent reports have indicated that it may lead to cirrhosis and graft failure. 2,8,12 Furthermore, the immunoreactive propensity of the recipient may contribute to greater frequencies of acute rejection, steroid-resistant rejection, and chronic rejection, especially if corticosteroids are withdrawn in the posttransplantation period.…”

mentioning

confidence: 99%

“…2,8,12 Furthermore, the immunoreactive propensity of the recipient may contribute to greater frequencies of acute rejection, steroid-resistant rejection, and chronic rejection, especially if corticosteroids are withdrawn in the posttransplantation period. [12][13][14][15] The reasons for recurrent disease are unclear, but associations have been made with corticosteroid withdrawal, 5,9,11,16 implantation of an HLA-DR3-negative liver into a HLA-DR3-positive recipient, 5,6,17 immunosuppressive regimens based on tacrolimus, 8,10,12 and pediatric propensities for aggressive disease. 8 However, findings in various centers have been discrepant regarding the prevalence of recurrence, its consequences, and its risk factors.…”

mentioning

confidence: 99%

“…8 However, findings in various centers have been discrepant regarding the prevalence of recurrence, its consequences, and its risk factors. The importance of HLA-DR3 mismatching between donor and recipient 3,5,6,11,12,13 and the impact of corticosteroid withdrawal on the recurrence of autoimmune hepatitis 5,9,14,18 are now disputed. Optimal results after transplantation require clarification of factors contributing to recurrence and better understanding of the frequency and consequences of recurrent disease.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Recurrent autoimmune hepatitis after orthotopic liver transplantation

González-Koch¹,

Czaja²,

Carpenter³

et al. 2001

Liver Transpl

182

156

View full text Add to dashboard Cite

To determine the frequency, risk factors, and consequences of recurrent autoimmune hepatitis after liver transplantation, 41 patients with type 1 disease were monitored after surgery in accordance with a surveillance protocol. Tacrolimus or cyclosporine plus prednisone were administered to each patient, and liver biopsy examinations were performed at least annually according to protocol. Corticosteroid therapy was ultimately discontinued in only 2 patients. Recurrent disease was defined as the presence of lymphoplasmacytic infiltrates in liver tissue in the absence of other causes of allograft dysfunction. Autoimmune hepatitis recurred in 7 patients (17%), and the mean time to recurrence was 4.6 ؎ 1 years. Recurrence was asymptomatic in 4 of 7 patients and detected only by surveillance liver biopsy assessment in 2 patients. Histological changes were mild, and there was no progression to cirrhosis during 4.9 ؎ 0.9 years of observation. Five-year patient (86% v 82%; P ‫؍‬ .9) and graft (86% v 67%; P ‫؍‬ .5) survival rates were not statistically different between patients with and without recurrent disease. HLA-DR3 or HLA-DR4 occurred more commonly in patients with than without recurrence (100% v 40%; P ‫؍‬ .008) and healthy subjects (100% v 49%; P ‫؍‬ .01). Recurrent disease was unrelated to donor HLA status. In conclusion, recurrence after transplantation for type 1 autoimmune hepatitis is common. Its mild manifestations and favorable prognosis may reflect early detection by a surveillance protocol and/or continuous corticosteroid treatment. L iver transplantation is effective in the treatment of decompensated autoimmune hepatitis. Five-year patient and graft survival rates range from 83% to 92%, 1,2 and the actuarial 10-year survival rate after transplantation is 75%. 3,4 Furthermore, autoantibodies and hypergammaglobulinemia disappear in most patients within 2 years. 1,2 Despite these successes, recurrent disease is possible, 2,3,5-13 and recent reports have indicated that it may lead to cirrhosis and graft failure. 2,8,12 Furthermore, the immunoreactive propensity of the recipient may contribute to greater frequencies of acute rejection, steroid-resistant rejection, and chronic rejection, especially if corticosteroids are withdrawn in the posttransplantation period. [12][13][14][15] The reasons for recurrent disease are unclear, but associations have been made with corticosteroid withdrawal, 5,9,11,16 implantation of an HLA-DR3-negative liver into a HLA-DR3-positive recipient, 5,6,17 immunosuppressive regimens based on tacrolimus, 8,10,12 and pediatric propensities for aggressive disease. 8 However, findings in various centers have been discrepant regarding the prevalence of recurrence, its consequences, and its risk factors. The importance of HLA-DR3 mismatching between donor and recipient 3,5,6,11,12,13 and the impact of corticosteroid withdrawal on the recurrence of autoimmune hepatitis 5,9,14,18 are now disputed. Optimal results after transplantation require clarification of factors contributing to recurre...

show abstract

Recurrence of Autoimmune Chronic Active Hepatitis Following Orthotopic Liver Grafting

Cited by 156 publications

References 0 publications

Liver biopsy interpretation for causes of late liver allograft dysfunction

Liver biopsy interpretation for causes of late liver allograft dysfunction

Prednisone withdrawal advocates: Beware of recurrent autoimmune hepatitis

Recurrent autoimmune hepatitis after orthotopic liver transplantation

Contact Info

Product

Resources

About