Recurrent Autoimmune Hepatitis After Liver Transplantation

Review Article

Recurrent Autoimmune Hepatitis After Liver Transplantation

Albert J. Czaja

ABSTRACT

Background: Autoimmune hepatitis recurs after liver transplantation, but its recognition may be difficult because of immunosuppressive therapy and other superimposed conditions.

Aims: To review the nature, mechanisms, and treatment of recurrent autoimmune hepatitis, and to facilitate its prompt recognition and effective therapy.

Methods: Prime source and review articles in English were selected through MedLine from 1984 to 2009 and assimilated into personal libraries spanning this same interval.

Results: Autoimmune hepatitis recurs after liver transplantation in 12–46% of patients, and it usually develops 1–8 years after the procedure (median 2 years). The frequency increases from 12% at 1 year to 36% after 5 years, and progression to cirrhosis and graft failure is possible. Asymptomatic histological recurrence may precede clinical recurrence by 1–5 years, but its impact on prognosis is uncertain. The diagnostic requirements are the same as for native disease, but the findings may be less pronounced, and the exclusion of acute and chronic cellular rejection is essential. The risk of recurrence relates to the elapsed time after transplantation, frequency of acute and chronic rejection, and adjustments in the immunosuppressive regimen. Genetic predispositions of the patient and severity of the original disease may also contribute. Graft and patient survival ranges from 78% to 89%, and the disease usually responds to adjustments in the immunosuppressive regimen or the reintroduction of corticosteroids. Refractory disease may require other medication (another calcineurin inhibitor or rapamycin) or retransplantation.

Conclusions: Recurrent autoimmune hepatitis is common, potentially aggressive, but usually managed successfully.

Keywords: recurrence, transplantation, autoimmune hepatitis, treatment

Correspondence: Albert J Czaja, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, Minnesota 55905, USA. Tel: (1)‐507‐284‐8118; Fax: (1)‐507‐284‐0538; e‐mail: czaja.albert@mayo.edu