De novo autoimmune hepatitis following living-donor liver transplantation for primary biliary cirrhosis.
Since first being described in 1998, de novo autoimmune hepatitis (AIH) after liver transplantation has been reported in several cases suffering from non-autoimmune liver diseases and primary biliary cirrhosis (PBC). Glutathione S-transferase (GST) T1 genotype mismatches between donor and recipient have also been suggested to constitute a risk factor for de novo AIH. Here, we report a 33-yr-old woman who presented complaining of marked fatigue and jaundice four yr after living-donor liver transplantation for PBC. On examination, transaminase levels were highly elevated and ANA and antimitochondrial antibody M2 were positive. Histological findings showed zonal necrosis with lymphoplasmacytic infiltration closely resembling AIH. She had pretreatment AIH score of 16 and 19 points after relapse of de novo AIH. Two color fluorescence in situ hybridization with X and Y chromosome-specific probes clearly revealed that the hepatocytes were of donor origin and lymphocytes were of patient origin. The GSTT1 genotype of the patient and the donor were the same null type, suggesting that mechanisms other than GSTT1 mismatches may exist in de novo AIH development. In conclusion, recipient immune cells attacked the allogeneic transplanted liver of the patient via de novo AIH, although the exact participation of autoimmune mechanisms is unclear.
Yoshizawa
Kaname
K
Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan. kanamey@hsp.md.shinshu-u.ac.jp
Shirakawa
Haruaki
H
Ichijo
Tetsuya
T
Umemura
Takeji
T
Tanaka
Eiji
E
Kiyosawa
Kendo
K
Imagawa
Eri
E
Matsuda
Kazuyuki
K
Hidaka
Eiko
E
Sano
Kenji
K
Nakazawa
Yuichi
Y
Ikegami
Toshihiko
T
Hashikura
Yasuhiko
Y
Miyagawa
Shinichi
S
Ota
Masao
M
Nakano
Masayuki
M
D000328:Adult; D001323:Autoantibodies / Q000097:blood; D005260:Female; D005982:Glutathione Transferase / Q000235:genetics; D019693:Hepatitis, Autoimmune / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008928:Mitochondria / Q000276:immunology; D011183:Postoperative Complications; D012307:Risk Factors; D000637:Transaminases / Q000097:blood
D001323:Autoantibodies; C413545:glutathione S-transferase T1; D005982:Glutathione Transferase; D000637:Transaminases