Long‐term outcome of liver transplantation for autoimmune hepatitis: A French nationwide study over 30 years

Abstract

Background & Aims: Autoimmune hepatitis (AIH) is a rare indication for liver transplantation (LT). The aims of this study were to evaluate long-term survival after LT for AIH and prognostic factors, especially the impact of recurrent AIH (rAIH).Methods: A multicentre retrospective nationwide study including all patients aged ≥16 transplanted for AIH in France was conducted. Early deaths and retransplantations (≤6 months) were excluded. Results:The study population consisted of 301 patients transplanted from 1987 to 2018. Median age at LT was 43 years (IQR,). Median follow-up was 87.0 months (IQR, 43.5-168.0). Seventy-four patients (24.6%) developed rAIH.

Autoimmune hepatitis recurrence after liver transplantation: “Les jeux sont faits”

“…If the earliest rAIH was observed at 3.1 months in our cohort, the median time from LT to recurrence was 53.6 months and is consistent with existing literature, reporting times to recurrence ranging from 4 to 55 months 8,17 . Of note, rAIH has little impact on patient survival after LT 9,18 …”

“…If the earliest rAIH was observed at 3.1 months in our cohort, the median time from LT to recurrence was 53.6 months and is consistent with existing literature, reporting times to recurrence ranging from 4 to 55 months. [8,17] Of note, rAIH has little impact on patient survival after LT. [9,18] Previous reports identified several risk factors for rAIH, but the results of these studies are highly conflicting (summarized in Table 4). Prados et al [5] suggested that the presence of anti-LKM1 could be a protective factor for rAIH, whereas another study demonstrated that autoantibody titers before LT do not correlate with disease activity and prognosis.…”

“…In some cases, rAIH is severe, and patients may require retransplantation. [8,9] A frequently used strategy to prevent rAIH is the maintenance of a triple immunosuppressive regimen, including low-dose corticosteroids. Nevertheless, the safety and efficacy of this attitude remain questionable.…”

“…Even more than the initial diagnosis, rAIH diagnosis is challenging because of the persistent biological and clinical markers of autoimmunity, together with the absence of specific markers, and must be distinguished from acute and chronic rejection, viral infection, and drug toxicity. In some cases, rAIH is severe, and patients may require retransplantation 8,9 . A frequently used strategy to prevent rAIH is the maintenance of a triple immunosuppressive regimen, including low-dose corticosteroids.…”