Long-term outcome of liver transplantation for autoimmune hepatitis.
BACKGROUND
Liver transplantation is the final therapeutic option for about 10% of patients with autoimmune hepatitis (AIH) who do not respond to medical therapy. The aim of this study was to evaluate the long-term outcome in serologically defined subgroups of AIH after transplantation.


METHODS
Pre- and post-transplantation data of 28 patients with AIH transplanted between 1987 and 1999 were retrospectively analyzed and compared with 24 patients, who underwent liver transplantation because of Wilson's disease and glycogen storage disease type 1.


RESULTS
Serological analyses identified patients with AIH type 1 (n = 13), type 2 (n = 5), and type 3 (n = 10). The 5-yr patient survival rate after liver transplantation was 78.2%, which was not significantly different from the control group. Six AIH patients and four control patients required re-transplantation because of initial non-function, chronic rejection or AIH recurrence. Patients transplanted for AIH (88%) had more episodes of acute rejection when compared with patients transplanted for genetic liver diseases (50%). Clinical and histological features of chronic rejection were present in four patients, which did not differ significantly from the controls. Recurrence of AIH was diagnosed in nine patients (32%) based upon the presence of autoantibodies, increased gamma-globulins, steroid dependency, and histological evidence of chronic hepatitis. These combined features were not found in any of the controls.


CONCLUSIONS
Our data do not suggest that AIH subtypes influence prognosis after liver transplantation. Despite a high frequency of acute cellular rejection episodes and disease recurrence, transplantation for AIH has a 5-yr survival rate, which does not differ from that observed in patients transplanted for genetic liver diseases.
Vogel
Arndt
A
Department of a Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
Heinrich
Eyk
E
Bahr
Matthias J
MJ
Rifai
Kinan
K
Flemming
Peer
P
Melter
Michael
M
Klempnauer
Juergen
J
Nashan
Björn
B
Manns
Michael P
MP
Strassburg
Christian P
CP
D000293:Adolescent; D000328:Adult; D001323:Autoantibodies / Q000032:analysis; D016022:Case-Control Studies; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D019693:Hepatitis, Autoimmune / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D001323:Autoantibodies; D007166:Immunosuppressive Agents