RECURRENCE OF AUTOIMMUNE HEPATITIS IN CHILDREN AFTER LIVER-TRANSPLANTATION

Background: Liver transplantation is recognized as the appropriate tre atment for end-stage liver disease due to chronic active autoimmune he patitis. While it was initially thought that the disease did not recur after transplant, it is now generally accepted that adult patients ma y develop recurrent disease, with studies reporting a recurrence rate of less than or equal to 25%. We have noted a higher incidence of recu rrent autoimmune hepatitis in our pediatric patients undergoing liver transplant, with a high incidence of associated morbidity. Methods: We reviewed the records of six children followed up for autoimmune hepat itis who underwent orthotopic liver transplant for complications of en d-stage liver disease. Results: Of the six, five developed recurrent a utoimmune hepatitis at a mean time of 11.4 months after transplant. Th e disease was aggressive, leading to cirrhosis and retransplant in thr ee patients, within 1 year of recurrence. A second recurrence of disea se occurred in ail three retransplanted patients. One patient has rece ived a third liver transplant, one has died, and one patient is asympt omatic on medical therapy. Autoimmune hepatitis recurred in all four p atients receiving tacrolimus. Conclusion: We conclude that liver trans plant for autoimmune hepatitis is likely to be palliative for most ped iatric patients. Potent immunosuppressives such as tacrolimus do not p rotect against the development of recurrent autoimmune hepatitis. (C) 1997 Lippincott-Raven Publishers.