title: Idiopathic post-transplantation hepatitis following living donor liver transplantation, and significance of autoantibody titre for outcome.
abstract: Idiopathic post-transplantation hepatitis (IPTH) is a common histology occurring late after liver transplantation. Its natural history and the effect of treatment have not been determined. This study is a matched case-control study that evaluates predictors, outcome and response to treatment for IPTH. Patients were divided by autoantibodies into high-titre (> or = 1:160) and low-titre (<1:160) groups, so as to evaluate clinicopathological differences between the two groups. IPTH was identified in 42 of 944 recipients (4.4%) with tacrolimus-based immunosuppression. They comprised 10 males and 32 females, having median age 6.0 (0-50) years. IPTH presented at a median duration of 5.2 (0.7-10.8) years after transplantation. Particular risk of IPTH was associated with acute rejection, late-onset acute rejection occurring later than 6 month post-transplant, and autoantibody positivity. IPTH was associated with dependence on steroids and frequent adverse outcomes: retransplantation in five (12%); relapse in four (9.5%); and progression of fibrosis in eight (19%). The high-titre group and low-titre group did not differ in their clinicopathological features, response to treatment or outcome. To prevent the development of IPTH, appropriate adjustment of immunosuppression and close follow-up is necessary for patients who suffer repeated episodes of rejection.
authors.affiliation: Department of Diagnostic Pathology, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan. ayam@kuhp.kyoto-u.ac.jp
authors.forename: Aya
authors.initials: A
authors.lastname: Miyagawa-Hayashino
authors.forename: Hironori
authors.initials: H
authors.lastname: Haga
authors.forename: Hiroto
authors.initials: H
authors.lastname: Egawa
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Hayashino
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Manabe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood*; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology* / Q000473:pathology; D019693:Hepatitis, Autoimmune / Q000453:epidemiology / Q000276:immunology* / Q000473:pathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016031:Liver Transplantation / Q000276:immunology* / Q000706:statistics & numerical data; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000276:immunology* / Q000473:pathology; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001323:Autoantibodies