Autoimmune hepatitis recurrence after liver transplantation: "Les jeux sont faits".

Abstract

Autoimmune hepatitis (AIH) may recur after liver transplantation (LT). The aims of this study were to evaluate the incidence and risk factors for recurrent autoimmune hepatitis (rAIH). A multicenter retrospective French nationwide study, including all patients aged ≥16 transplanted for AIH, with at least 1 liver biopsy 1 year after LT, was conducted between 1985 and 2018. Risk factors for rAIH were identified using a multivariate Cox regression model. Three hundred and forty-four patients were included (78.8% women) with a median age at LT of 43.6 years. Seventy-six patients (22.1%) developed recurrence in a median time of 53.6 months (IQR, 14.1-93.2). Actuarial risk for developing rAIH was 41.3% 20 years after LT. In multivariate analysis, the strongest risk factor for rAIH was cytomegalovirus D+/R- mismatch status (HR=2.0; 95% CI: 1.1-3.6; p =0.03), followed by associated autoimmune condition. Twenty-one patients (27.6% of rAIH patients) developed liver graft cirrhosis after rAIH. Independent risk factors for these severe forms of rAIH were young age at LT, IgG levels >20.7 g/L, and LT in the context of (sub)fulminant hepatitis. Immunosuppression, especially long-term maintenance of corticosteroid therapy, was not significantly associated with rAIH. Recurrence of AIH after LT is frequent and may lead to graft loss. Recurrence is more frequent in young patients with active disease at the time of LT, yet systematic corticosteroid therapy does not prevent it.

• Authors: Yasmina Chouik, Christophe Corpechot, Claire Francoz, Eleonora De Martin, Olivier Guillaud, Armand Abergel, Mario Altieri, Louise Barbier, Camille Besch, Olivier Chazouillères, Filomena Conti, Sébastien Dharancy, François Durand, Christophe Duvoux, Jean Gugenheim, Jean Hardwigsen, Marie-Noëlle Hilleret, Pauline Houssel-Debry, Nassim Kamar, Anne Minello, Martine Neau-Cransac, Georges-Philippe Pageaux, Sylvie Radenne, Olivier Roux, Faouzi Saliba, Didier Samuel, Claire Vanlemmens, Marie-Lorraine Woehl-Jaegle, Vincent Leroy, Jean-Charles Duclos-Vallée, Jérôme Dumortier
• Journal: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (Liver Transpl) Vol. 30 Issue 4 Pg. 395-411 (Apr 01 2024) ISSN: 1527-6473 [Electronic] United States
• PMID: 37788303 (Publication Type: Multicenter Study, Journal Article)
• Copyright: Copyright © 2023 American Association for the Study of Liver Diseases.

Chemical References

• Immunosuppressive Agents
• Adrenal Cortex Hormones

Topics

• Humans
• Female
• Adult
• Male
• Liver Transplantation (adverse effects)
• Hepatitis, Autoimmune (epidemiology, surgery)
• Immunosuppressive Agents (adverse effects)
• Retrospective Studies
• Liver Cirrhosis (complications)
• Adrenal Cortex Hormones
• Recurrence