Autoimmune hepatitis (AIH) may recur after orthotopic liver transplantation (OLT) in between 10 to 35% of patients.
In this study, researchers examined the clinical and histological outcome more than 10 years after OLT for AIH.
Their findings are published in the June issue of Gut.
|4 patients had histological abnormalities detected 1 to 5 years before the onset of biochemical abnormalities.|
The team selected 17 women from 44 patients who were transplanted for AIH.
They determined that the criteria for definite AIH, established by the International Autoimmune Hepatitis Group, were met in every case.
The women had a mean age of 30 years at the time of OLT, and the researchers followed them for more than 10 years.
They performed liver biopsies 1, 2, 5, and 10 years after OLT, and also when indicated by abnormal liver function tests.
The researchers examined specimens for evidence of recurrent AIH: interface hepatitis, lobular activity, portal lymphoplasmocytic infiltration, and fibrosis.
They also looked for other signs of recurrence including hypertransaminasemia, serum autoantibodies, and response to steroid reintroduction or significant steroid dose increments.
The team found that AIH recurred in 41% of patients.
In 4 of the patients histological abnormalities were detected by means of protocol biopsies between 1 and 5 years before the onset of biochemical abnormalities.
A further 2 patients developed severe recurrences after 10 and 15 years, respectively. These patients required treatment with steroids and tacrolimus.
The remaining 3 patients had histological recurrence detected 0.6 to 3 years post-OLT, concomitantly with biochemical abnormalities.
Dr Duclos-Vallée's team concluded, "AIH recurred in 41% of patients followed for more than 10 years after OLT".
"As histological signs preceded biochemical abnormalities in 4 patients, regular liver biopsy is warranted after OLT".
"Detection of isolated histological signs may call for closer follow up and/or a change in immunosuppressive therapy".