Subtypes of antimitochondrial antibodies in primary biliary cirrhosis before and after orthotopic liver transplantation

Abstract

Antimitochondrial antibodies are markers for primary biliary cirrhosis and probably reflect a specific defect in immunoregulation underlying this disease. Antimitochondrial antibodies and their primary biliary cirrhosis-specific subtypes were tested before and up to 6 years after orthotopic liver transplantation. Sera from 31 consecutive patients were tested, 15 patients had primary biliary cirrhosis and 16 non-primary biliary cirrhosis. Antimitochondrial antibodies were investigated under code by immunofluorescence, and primary biliary cirrhosis-specific subtypes were determined by radioimmunoassay (anti-p62, anti-p48) and complement fixation test (anti-M2, anti-M4, anti-M8). Before orthotopic liver transplantation, antimitochondrial antibodies were detected by immunofluorescence in 13 of 15 patients with primary biliary cirrhosis. Of these patients, 12 were positive for anti-p62 and 8 for anti-p48. Ten patients were positive for anti-M2, 4 patients for anti-M4 and 7 patients for anti-M8. Two primary biliary cirrhosis patients and all non-primary biliary cirrhosis patients were negative with all tests. One month after orthotopic liver transplantation, antimitochondrial antibodies titers declined or became negative by antimitochondrial antibodies immunofluorescence, 3 patients became negative by radioimmunoassay for anti-p62 and 1 for anti-p48. With complement fixation test, 4 patients became negative for anti-M2, 2 for anti-M4 and 4 for anti-M8. Antimitochondrial antibody titer reduction observed 1 month after orthotopic liver transplantation remained unchanged in most sera during the following years. A rise was observed in two patients after 4 and 5 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Transplantation for primary biliary cirrhosis

“…Our experience suggests that truly recurrent disease is quite unusual. Similar results were reported by Haagsma et al (20), who found no evidence of recurrence of PBC in 9 liver transplant recipients followed for at least 1 yr. Attention to the fine details of the type of inflammatory cells found mostly in the portal areas, the degree to which these cells infiltrate the surrounding parenchyma, and the presence or absence of subintimal foamy macrophages and true cirrhosis (regenerative nodules and fibrosis) apparently make it possible to distinguish between these two entities.…”

Pathologic analysis of liver transplantation for primary biliary cirrhosis

“…ei~her this series (13) or that of Haagsma et a1. (23). SImIlarly, no apparent correlation between the AMA titers and presence of chronic rejection was seen in this study.…”

Disease recurrence after living liver transplantation for primary biliary cirrhosis: A clinical and histological follow-up study

“…Thus, in approximately 80% of patients with PBC with cadaveric grafts, AMA was detectable after transplantation, although titers decreased steeply, particularly during the first year. [2][3][4]7,9,16,17 We were unable to evaluate a possible difference between patients with grafts from blood relatives versus grafts from non-blood relatives because we had only 1 patient with a graft from a non-blood relative. She was positive for AMA and anti-PDC-E2 before LLT, but had multiple HLA matches.…”

“…One of the most common indications for adult LLT is primary biliary cirrhosis (PBC). Based on experience with cadaveric liver transplantations, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] PBC must be expected to recur in some of these patients. Recurrence of PBC in allografts is suspected when such immunologic abnormalities as antibodies against mitochondrial components and increased immunoglobulin M (IgM) concentrations persist and extrahepatic manifestations of PBC develop or fail to recede.…”