Increased incidence of chronic rejection in adult patients transplanted for autoimmune hepatitis: Assessment of risk factors

Background/Aim. It remains uncertain whether autoimmune hepatitis (AIH), as an original indication for orthotopic liver transplantation (OLTX), predis poses to the development of chronic rejection (CR) after surgery and publis hed reports on heterogenous groups of patients provided conflicting data. I n this work we analyzed the incidence and risk factors for CR in a large co hort of adult patients transplanted for AIH in our unit. Results. A total of 1190 adult patients received OLTX in our center between 1982 and 1998, A total of 77 patients (6.5%) were transplanted for AIH and 12 (15.6%) patients from this group developed clinical and histological fe atures of CR within a median time of 3.5 months after OLTX, Patients with A IH who developed CR were younger than other AIH patients: at OLTX (32 vs. 4 4.2 ys; P=0.015) and more often had histological features of moderate or se vere acute rejection (83 vs. 34%; P=0.002) on early post-OLTX biopsies. The incidence of CR in AIH patients was significantly higher than in subjects transplanted for other indications such as primary biliary cirrhosis (8.2%; P<0.05), primary sclerosing cholangitis (5.2%; P<0.05) or alcoholic cirrho sis (2.0%; P<0.001). Also, we observed a tendency to decreased incidence of CR with time in all transplanted subjects. Conclusions. Apart from younger age at OLTX and higher incidence of severe acute rejection, patients with AIH who developed CR did not differ from oth er subjects transplanted for this indication. Unlike other studies, not str atified by diagnosis, recipient CMV negative status, young donor age, and H LA DR matching were not identified as risk factors for CR in AIH.