Recurrence of autoimmune disease, primary sclerosing cholangitis, primary biliary cirrhosis, and autoimmune hepatitis after liver transplantation.
1. Recurrence of primary sclerosing cholangitis. a Five percent of liver transplants are performed because of end-stage liver disease secondary to primary sclerosing cholangitis. b Recurrent disease affects 10% to 27% of recipients. c Diagnostic criteria of recurrence include the following: A confirmed diagnosis of primary sclerosing cholangitis before liver transplantation. A cholangiogram showing nonanastomotic biliary strictures with beading and irregularity occurring 90 days after transplantation. Liver biopsy revealing fibrous cholangitis and/or fibro-obliterative lesions of large bile ducts. d The data argue for an association between recurrent primary sclerosing cholangitis and rejection and steroid therapy. 2. Recurrence of primary biliary cirrhosis. a Overall recurrence rates can reach 50%. b The gold standard for diagnosis is histological, with bile duct destruction by granulomas indicated by a florid lesion. c Anti-mitochondrial antibody is not a reliable marker of recurrence. d Recurrence does not affect long-term patient or graft survival. 3. Recurrence of autoimmune hepatitis. a Recurrence affects approximately 25% of liver allografts during the first 5 years after liver transplantation and more than 50% after 10 years of follow-up. b Diagnostic criteria of recurrence must include a combination of biochemical changes, (elevated serum aminotransferases levels and hypergammaglobulinemia), histological features of autoimmune hepatitis, and steroid dependency. c Immunosuppressive therapy should be pursued even if liver test results are normal.
Duclos-Vallee
Jean-Charles
JC
Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France. jean-charles.duclos-vallee@pbr.aphp.fr
Sebagh
Mylène
M
D015209:Cholangitis, Sclerosing / Q000473:pathology* / Q000601:surgery; D019693:Hepatitis, Autoimmune / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000473:pathology* / Q000601:surgery; D016031:Liver Transplantation; D011183:Postoperative Complications / Q000473:pathology / Q000601:surgery; D012008:Recurrence; D012307:Risk Factors