Liver transplantationOutcomeLiver Transplantation for Autoimmune Hepatitis: A Single-Center Experience
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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Cited by (58)
Post-Transplant Immunosuppression in Autoimmune Liver Disease
2023, Journal of Clinical and Experimental HepatologyRisk factors and outcomes associated with recurrent autoimmune hepatitis following liver transplantation
2022, Journal of HepatologyLong Term Outcomes of Liver Transplantation For Patients With Autoimmune Hepatitis
2021, Transplantation ProceedingsApproach to the patient with acute severe autoimmune hepatitis
2020, JHEP ReportsCitation Excerpt :The decision to proceed to urgent listing should be made within a multidisciplinary setting with intensivists, transplant physicians and surgeons. Outcomes for LT in AS-AIH and AIH-ALF are similar to those of other aetiologies of ALF (1-year survival 80–94%).122,123 Although the frequency of post-transplant rejection (acute/late) is increased in patients with AIH compared to those with non-AIH disease, the frequency of rejection is similar between patients with acute or chronic AIH.124–127
De novo and recurrent liver disease
2020, Best Practice and Research: Clinical GastroenterologyCitation Excerpt :Treatment of rAIH depends on the clinical presentation (Fig. 2). Asymptomatic patients with minimal changes in serum liver tests and/or histologic features can be treated with minor increases to the current immunosuppression regimen [26,27]. On the other hand, patients with severe rAIH should be treated with prednisone or prednisolone (30 mg daily) with concomitant azathioprine (1–2 mg/kg daily).
Autoimmune Hepatitis in the Liver Transplant Graft
2017, Clinics in Liver DiseaseCitation Excerpt :A score of 6 or higher indicates probable AIH, and a score of 7 or higher indicates AIH.8 The incidence of recurrent AIH among adult patients undergoing LT reported in the literature is between 7% and 41%9–23 and a recent systematic review reported a weighted recurrence rate of AIH of 22% (Table 2).24 Timing of recurrence is also variable, but is usually reported to occur more than 12 months after LT.9–23 The variability in recurrence rates and timing of recurrence reported in the literature may be partially accounted for by variability in study methodology, diagnostic criteria selection, follow-up period, timing of protocol and nonprotocol biopsies, immunosuppression use, and other factors.