Liver transplantation
Outcome
Liver Transplantation for Autoimmune Hepatitis: A Single-Center Experience

https://doi.org/10.1016/j.transproceed.2007.02.030Get rights and content

Abstract

Objective

To present our experience with deceased donor liver transplantation (DDLT) and living-donor liver transplantation (LDLT) for autoimmune hepatitis (AIH).

Patients and Method

Between April 2001 and November 2006, a total of 116 LT procedures were performed (73 DDLTs and 43 LDLTs) in 112 patients (4 retransplants). Of the 112 recipients, 16 patients (14.3%) were transplanted for AIH (15 DDLTs and 1 LDLT). All recipients received FK506- and steroid-based immunosuppressive regimens.

Results

The male/female ratio was 3/13, median age was 22 years (range, 15 to 35), and the median MELD score was 25 (range, 11 to 40). Arterial reconstruction was needed in four DDLTs due to severe steroid-induced angiopathy. After a median follow-up period of 530 days (range, 11 to 2016), the overall patient and graft survival rates were 93.8%. Only one patient died following LDLT due to primary graft nonfunction. Histopathologic recurrence was seen in three patients (18.7%) and was successfully treated by optimizing immunosuppression. Markedly elevated serum CA19-9 levels (median, 1069; range, 217 to 2855) was seen in four patients (28%), malignancy was ruled out and all patients normalized serum CA19-9 levels within the first 3 months posttransplant. Steroids withdrawal failed in all recipients and was always accompanied with almost immediate elevation of liver enzymes.

Conclusions

In our experience, LT for AIH shows excellent long-term outcomes, patients are usually young women who present with acute deterioration and high MELD scores, and usually require long-term steroids to prevent rejection and disease recurrence. Some patients have markedly high CA19-9 in absence of malignancy. Some patients also have severe steroid-induced hepatic artery angiopathy necessitating arterial reconstruction during the transplant surgery.

Section snippets

Patients and Methods

At King Faisal Specialist Hospital and Research Center from April 2001 to November 2006, a total of 116 LTs were performed (73 DDLTs and 43 LDLTs) in 112 patients (4 retransplants). Of 112 recipients, 16 patients (14.3%) were transplanted for AIH (15 DDLTs and 1 LDLT). Arterial reconstruction was needed during the transplant procedure in four patients who had very fragile intima of the hepatic artery, probably caused by long-term corticosteroid use as a treatment for AIH. Aortic conduit

Results

Characteristics of 16 patient transplanted for AIH are shown in Table 1; the male/female ratio was 3/13; median age was 22 years (range, 15 to 35); median MELD score was 25 (range, 11 to 40); median blood transfusion was 6 U (range, 0 to 65); median ICU stay was 5 days (range, 2 to 24), and median hospital stay was 11 days (range, 7 to 58). Out of 16 patients transplanted for AIH, 7 patients (44%) were not known to have any liver disease and they presented to our service with the clinical

Discussion

Liver transplantation is the final therapeutic option for about 10% of patients with AIH who do not respond to medical therapy.17 The reported grafts and patients survival rate at 5 years after liver transplantation is approximately 80% to 90%, the 10-year survival rate is approximately 75%, and the recurrence rate has been reported to be as high as 42%.1, 13, 17, 18, 19 In our experience, patients transplanted for AIH showed an exceptional good long-term outcome with the 3-year patient and

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