Long-term follow-up after liver transplantation for autoimmune hepatitis: evidence of recurrence of primary disease

Background/Aims: After liver transplantion for autoimmune hepatitis, the lo ng-term results and the incidence of recurrence of primary disease are unkn own, Methods: In this retrospective study we reviewed the clinical course of 25 patients transplanted for autoimmune hepatitis and followed for a mean of 5 .3 years (2-8.5 years). Results: The actuarial 5-year patient and graft survival rates were 91% (+/ -6%) and 83% (+/-8%), The actuarial 1-year rate of acute rejection was 50% (+/-10.2%), which was comparable to that of patients transplanted for prima ry biliary cirrhosis and primary sclerosing cholangitis. Autoantibodies per sisted in 77% of patients, at a lower titer than before liver transplantati on. Ten patients were excluded from the study of autoimmune hepatitis recur rence, one because of an early postoperative death and nine because of hepa titis C virus infection acquired before or after liver transplantation. In the remaining 15 patients, who were free of hepatitis C virus infection, 5- year patient and graft survivals were 100% and 87%, respectively. Despite t riple immunosuppressive therapy, three patients (20%) developed chronic hep atitis with histological and serological features of autoimmune hepatitis i n the absence of any other identifiable cause. The disease was severe in tw o patients, leading to graft failure and asymptomatic in another, despite m arked histological abnormalities. In one of these three patients, autoimmun e hepatitis recurred on the second liver graft as well. Conclusions: Patients undergoing liver transplantation for autoimmune hepat itis have an excellent survival rate although severe primary disease may re cur, suggesting the need for stronger post-operative immunosuppressive ther apy.