Liver transplantation for autoimmune hepatitis: A long-term pathologic study

Autoimmune hepatitis (AIH) after liver transplantation (LT) may recur and i s difficult to diagnose. Our aims were to define the histopathology of and factors related to AIH recurrence. Fourteen of 475 patients received LT for AIH; 2 died perioperatively. Li-ver specimens (native and post-LT biopsies ) from 12 other patients were reviewed and correlated with pre- and post-LT clinical course and outcome. Recurrent AIH was seen in 5 of 12 patients, 3 5 to 280 days post-LT as lobular hepatitis with acidophil bodies and lympho plasmacytic infiltrate. Portal/interface hepatitis was seen with disease pr ogression and 2 of 5 patients developed cirrhosis, Of 7 nonrecurrent patien ts, 1 had acquired hepatitis C with lobular/portal hepatitis and none devel oped cirrhosis. Histology suggestive of overlap syndrome was seen in 3 of 1 2 native livers with no effect on post-LT course or pathology. High-grade n ecroinflammation was present in native livers at LT in 5 of 5 cases with re current AIH and in 1 of 7 without recurrence (P < .01), Pre-LT disease dura tion, donor/recipient gender distribution, HLA studies, and rejection episo des did not correlate with AIH recurrence. We conclude that (1) recurrent A IH is not uncommon and was seen in 42% of patients with lymphoplasmacytic l obular, portal, and interface hepatitis; (2) acidophil bodies with lymphopl asmacytic cells are seen in early recurrent AIH; (3) recurrent AIH appears at variable time periods post-LT, and the progression is slow; and (4) high -grade inflammation in native liver at LT is a strong predictor of recurren t AIH.