Graft dysfunction mimicking autoimmune hepatitis following liver transplantation in adults

Citation
Ma. Heneghan et al., Graft dysfunction mimicking autoimmune hepatitis following liver transplantation in adults, HEPATOLOGY, 34(3), 2001, pp. 464-470
Citations number
26
Categorie Soggetti
Gastroenerology and Hepatology","da verificare
Journal title
HEPATOLOGY
ISSN journal
02709139 → ACNP
Volume
34
Issue
3
Year of publication
2001
Pages
464 - 470
Database
ISI
SICI code
0270-9139(200109)34:3<464:GDMAHF>2.0.ZU;2-M
Abstract
In children, a type of graft dysfunction associated with autoimmune feature s has been described. We have identified 7 adult liver-transplant (LT) reci pients from a series of over 1,000 consecutive transplant recipients who pr esented between 0.3 years and 7.2 years following transplantation with char acteristic symptoms, autoantibody profiles, and histologic findings of auto immune disease. The indications for transplantation were Ecstasy overdose, alcohol-related cirrhosis, primary sclerosing cholangitis (PSC) (2), primar y biliary cirrhosis (PBC), hepatitis C cirrhosis, and cryptogenic cirrhosis . Two patterns of de novo autoantibody development were noted; anti-liver-k idney-microsome (LKM) antibody development at high titer in association wit h an aspartate transaminase (AST) > 500 and antinuclear (ANA) and antismoot h muscle (AMA) antibody development at titers > 1/80 with lower AST levels. All cases had elevated IgG. Liver biopsies showed changes of an autoimmune -type hepatitis with portal and periportal hepatitis in association with a marked infiltrate of plasma cells, lymphocytes, and bridging collapse. Two patients lost their grafts because of the disease. Patients were treated wi th reintroduction of steroids and azathioprine in cases in which it had bee n withdrawn. Major histocompatibility class I and II mismatching did not in cur risk. Eight of 12 liver allografts were acquired from either DRB*0301- or DRB*0401-positive donors, and 4 recipients were DRB*0301-positive. This series illustrates that both symptoms and histologic findings of graft dysf unction compatible with autoimmune hepatitis (AIH) exist in adult LT recipi ents. Graft loss may be a consequence. This entity may represent a specific type of rejection that should currently be classified as "graft dysfunctio n mimicking autoimmune hepatitis."