Liver transplantation for autoimmune hepatitis

Publications about liver transplantation (LTX) for autoimmune hepatitis (AI H) have started to emerge, but many issues remain unresolved. We reviewed d ata on 32 patients transplanted for AIH to determine how pretransplantation and posttransplantation characteristics correlate with recipient outcome, including disease recurrence. Recipients were 37 +/- 14 years old; 30 of 32 were women. Most had chronic disease (8 +/- 6 years); 25% had fulminant fa ilure. The majority had ascites (91%), jaundice (88%), elevated prothrombin time (18 +/- 3 seconds), and hypoalbuminemia (2.7 +/- 0.6 g/dL), All had h ypergammaglobulinemia (3.0 +/- 1.0 g/dL) and autoantibodies (72% antinuclea r, 74% smooth muscle). Only one was HLA A1-B8-DR3 positive. Other autoimmun e disorders affected 25% of patients; half improved after transplantation. Actuarial survival was 81% at 1 and 2 years posttransplantation. There was a high frequency of rejection (75% of recipients had 1.7 +/- 0.8 episodes), and 39% of rejections required OKT3, Among 24 recipients with long-term fo llow-up (27 +/- 14 months), histologically proven recurrent AIH occurred in 25%, 15 +/- 2 months posttransplantation; half (3 patients) required retra nsplantation 11 +/- 3 months after diagnosis, After retransplantation 2 of 3 patients had re-recurrence within 3 months; 1 received a third LTx, Recur rence occurred in 6 of 18 patients transplanted for chronic disease vs. 0 o f 6 transplanted as fulminants (P = not significant [NS]). Patients with an d without recurrence had similar rejection profiles. In summary, results of LTx for AIH are excellent. However, AIH patients have a high frequency of rejection and often require OKT3. Furthermore, severe recurrent AIH sometim es develops, particularly in chronic versus fulminant AIH patients and in t hose already retransplanted for recurrence. Multicenter studies could eluci date the best posttransplantation immunosuppressive regimens for AIH patien ts.