Autoimmune hepatitis as a late complication of liver transplantation

Hector M. Hernandez, Paula Kovarik, Peter F. Whitington, Estella M. Alonso*

*Corresponding author for this work

Research output: Contribution to journalArticle

103 Scopus citations

Abstract

Background: The development of de novo autoimmune hepatitis as a long-term complication after liver transplantation has been recently reported. The authors describe five liver allograft recipients who developed chronic hepatitis associated with autoimmune features. Methods: Five of 155 liver transplant recipients at risk (2.5%) developed this particular form of graft dysfunction. The authors review the clinical records liver histology, therapy, and outcome of these five patients. Results: Patients included two boys and three girls. Median age I at transplantation was 3.5 years (range, 0.5-14 years), median age at presentation was 9 years (range 2-17 years) and median interval after transplantation was 5.1 years (range, 1.5-9 years). Indications for liver transplant included biliary atresia in four. patients and primary sclerosing cholangitis in one patient. At the time of presentation, all patients were receiving cyclosporine as their primary immunosuppressive agent. Only one patient had a history of rejection, which had resolved. All patients presented with increased transaminase levels, and one had a mildly elevated conjugated bilirubin level. Only one patient had constitutional complaints. Acute and chronic rejection, viral hepatitis, vascular insufficiency, and biliary tract obstruction were excluded. Antinuclear antibody levels were elevated in four patients (titer range, 1:160-1:640), one of whom also had positive antismooth muscle antibody (titer 1:80) results. The fifth patient had an elevated serum total protein level. Histologic analysis of liver biopsy samples from the five patients showed findings consistent with chronic autoimmune hepatitis. All patients were treated with standard therapy for autoimmune hepatitis, which included daily steroids and azathioprine. Cyclosporine doses were reduced in three patients and eliminated in two. All patients responded with normalization (n = 2) or improvement (n = 3) of liver transaminases within the first 3 months of therapy. Histologic analysis of the 3-month follow-up liver biopsy was normal (n = 2) or showed improvement in inflammation (n = 2). Two patients developed acute allograft rejection within 6 to 12 months after discontinuation or reduction in cyclosporine. Conclusions: Autoimmune hepatitis occurs after liver transplantation in patients without a previous history of autoimmune hepatitis. The risk of developing autoimmune hepatitis appears to be greater in children after liver transplantation than in the general pediatric population. Standard therapy for autoimmune hepatitis is effective.

Original languageEnglish (US)
Pages (from-to)131-136
Number of pages6
JournalJournal of pediatric gastroenterology and nutrition
Volume32
Issue number2
DOIs
StatePublished - Apr 19 2001

Keywords

  • Autoimmune hepatitis
  • Liver graft dysfunction
  • Liver transplantation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology

Fingerprint Dive into the research topics of 'Autoimmune hepatitis as a late complication of liver transplantation'. Together they form a unique fingerprint.

Cite this