Successful tacrolimus therapy for a severe recurrence of type 1 autoimmunehepatitis in a liver graft recipient

A 34-year-old woman underwent orthotopic liver transplantation (OLT) for de compensated type 1 autoimmune hepatitis (AIH). She was administered standar d triple-drug immunosuppressive therapy (cyclosporine, steroids, and azathi oprine). Ten years after OLT, she developed a recurrence of AIH, with emerg ence of serological markers of autoimmunity (high anti-smooth muscle antibo dy [ASMA] titer, high serum gamma globulin level), abnormal liver function test results, and characteristic histological features on liver biopsy. Des pite intensified steroid therapy, her clinical and liver function deteriora ted. The onset of cutaneous alternariosis led to a steroid dose reduction a nd cyclosporine replacement by tacrolimus. Clear-cut amelioration was obser ved, with an improvement in liver function test results and reduction in AS MA titer. One year after the recurrence of AIH, the patient has normal Live r function and physical findings. Tacrolimus therefore maybe effective in p atients with severe recurrent autoimmune liver disease. Further studies are needed to assess tacrolimus therapy in patients who fail to respond to sta ndard immunosuppressive therapy.