Recurrence of autoimmune hepatitis after liver transplantation without elevation of alanine aminotransferase

Abstract

It is controversial whether steroid therapy should be continued to prevent the recurrence of autoimmune hepatitis (AIH) in patients who have undergone liver transplantation (LTx) due to AIH. We report a case of recurrent autoimmune hepatitis after LTx despite a persistently normal range of alanine aminotransferase (ALT). A 50-year-old woman was admitted to our hospital because of jaundice and severe liver dysfunction, where she was diagnosed with liver failure due to AIH. Steroid therapy was not effective enough and the patient received living-donor LTx in 1999. Following the operation, the level of ALT was maintained within a normal range and anti-nuclear antibody (ANA) became negative, however, the serum level of IgG gradually elevated and ANA became positive, while platelets decreased. A liver biopsy performed 6 years after LTx showed histological findings of AIH and she was diagnosed with recurrent AIH. A recurrence of AIH may occur after LTx even if the level of ALT remains within a normal range. We consider that a protocol liver biopsy should be performed in patients who undergo LTx due to AIH to decide the indication for steroid therapy.

Recurrent and De Novo Autoimmune Hepatitis

“…Patients may be asymptomatic, and the diagnosis could be considered only because surveillance tests reveal serum aminotransferase abnormalities and the need for liver tissue examination. Other patients may have normal liver tests but abnormal protocol‐directed liver tissue examinations . An acute severe hepatitis is a rare possibility because of concurrent immunosuppressive therapy.…”

“… * Features may be less pronounced, absent, or otherwise atypical in part because of concurrent antirejection therapy: Duclos‐Vallée et al (2003); Yao et al (2007); O’Grady (2010). …”

Thyroglobulin measurement in fine‐needle aspiration biopsy of metastatic lymph nodes after rhTSH stimulation

“…Another limitation of our study is that liver biopsies were not protocolized but instead were performed only in the context of graft dysfunction evaluation; therefore, it is possible that the incidence of autoimmune hepatitis recurrence has been underestimated. However, all the patients evaluated in this study had at least 1 liver biopsy during their follow‐up, the frequency of autoimmune hepatitis recurrence in the absence of abnormal biochemistries is unusual, and the significance of clinically and biochemically silent recurrence is unknown 36…”

Recurrent autoimmune hepatitis after liver transplantation: A disease continuum or a fresh start?

“…Autoimmune hepatitis recurs after liver transplantation in 12% to 46% of patients, and it usually develops 1 to 8 years after the procedure (median time to recurrence, 2 years) 1–15. The frequency of recurrent autoimmune hepatitis increases with time after transplantation from 12% at 1 year to 36% after 5 years,14 and progression to cirrhosis and graft failure is possible 7.…”

“…The frequency of recurrent autoimmune hepatitis increases with time after transplantation from 12% at 1 year to 36% after 5 years,14 and progression to cirrhosis and graft failure is possible 7. Histological recurrence in the absence of clinical and laboratory manifestations may boost these frequencies, but the true nature of silent recurrence remains unclear 15. It may reflect the serendipitous detection of an indolent process that would have become clinically evident later or one that is so mild as to be inconsequential 13.…”