Outcome of autoimmune hepatitis after liver transplantation

Background. Recurrence of autoimmune hepatitis after liver transplantation is not rare, but there is little information about its time of onset, risk factors, response to treatment and prognosis. The aim of this study was to evaluate the rate of recurrence and outcome of autoimmune hepatitis after t ransplantation. Methods. The records of patients transplanted in eight centers in our count ry between 1984 and 1996 were retrospectively analyzed. Results. Forty-three of the 2331 (1.8%) recipients fulfilled diagnostic cri teria of autoimmune hepatitis at the time of transplantation. Sixteen patie nts were excluded from evaluation. Nine (33%) of the 27 patients evaluated fulfilled criteria for recurrence of autoimmune hepatitis, with a mean time of recurrence after orthotopic liver transplantation of 2.6+/-1.5 years. P atients with recurrence had a longer follow-up time after transplantation ( 5.1 vs. 2.5 years, P=0.0012) and were receiving less immunosuppressive trea tment, The estimated risk of recurrence of autoimmune hepatitis in the graf t increased over time: 8% over the first year and 68% 5 years after transpl antation. None of the seven patients with liver-kidney microsomal-positive antibodies recurred (P=0.059). Fifty percent of the patients failed to resp ond or responded only partially to therapy, although none of the patients h ave deteriorated clinically after 2.4+/-1.06 years of follow-up after recur rence. Conclusions. Recurrence of autoimmune hepatitis in the graft is a common ev ent with an incidence that increases over time as immunosuppression is redu ced. Although response to treatment is poor, patient and graft survival do not appear to be decreased.