Incidence and recurrence of autoimmune/alloimmune hepatitis in liver transplant recipients.
We prospectively collected data on 1,429 liver transplant recipients between December 1984 and December 1998. Fifty-five patients (3.8%; 10 men, 45 women; median age, 44.5 +/- 13 [SD] years) with autoimmune hepatitis (AIH) underwent orthotopic liver transplantation (OLT). Transplant recipients with AIH were younger, more likely to be women, and had a greater likelihood of rejection in the first 3, 6, and 12 months. There was no difference in patient survival or graft survival. There were 11 biopsy-proven recurrences (1 man, 10 women) of AIH after OLT. Almost half the episodes occurred within the first year after OLT. No patient required re-OLT because of recurrent disease. AIH has an incidence of 4% and a recurrence rate of 20% in OLT. Transplant recipients are more likely to be young women and have an increased incidence of acute cellular rejection (ACR) during the first post-OLT year. Recurrence should be suspected in those with abnormal liver function test results in the absence of ACR, especially during the first year after OLT. We cannot establish with certainty whether the observed process represents recurrence of the original autoimmune disease, an alloimmune phenomenon, or allograft dysfunction mimicking AIH.
Molmenti
Ernesto P
EP
Transplantation Services, Baylor University Medical Center, Dallas, TX 75246, USA.
Netto
George J
GJ
Murray
Natalie G
NG
Smith
Douglas M
DM
Molmenti
Hebe
H
Crippin
Jeffrey S
JS
Hoover
Tyrone C
TC
Jung
Ghapjoong
G
Marubashi
Shigeru
S
Sanchez
Edmund Q
EQ
Gogel
Brian
B
Levy
Marlon F
MF
Goldstein
Robert M
RM
Fasola
Carlos G
CG
Gonwa
Thomas A
TA
Klintmalm
Goran B
GB
D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D019693:Hepatitis, Autoimmune / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies
D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D001379:Azathioprine