Single-Center North American Experience of Liver Transplantation in Autoimmune Hepatitis: Infrequent Indication but Good Outcomes for Patients

Fernanda de Quadros Onofrio; Evon Neong; Danielle Adebayo; Dagmar Kollmann; Oyedele Adewale Adeyi; Sandra Fischer; Gideon Morris Hirschfield; Bettina Elisabeth Hansen; Mamatha Bhat; Zita Galvin; Leslie Blake Lilly; Nazia Selzner

doi:10.1093/jcag/gwaa022

Single-Center North American Experience of Liver Transplantation in Autoimmune Hepatitis: Infrequent Indication but Good Outcomes for Patients

J Can Assoc Gastroenterol. 2020 Jul 20;4(3):137-144. doi: 10.1093/jcag/gwaa022. eCollection 2021 Jun.

Affiliations

¹ Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada.
² Multi-Organ Transplant Program, University Health Network, Toronto, Ontario, Canada.
³ Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, Minnesota, USA.
⁴ Department of Pathology, University Health Network, Toronto, Ontario, Canada.
⁵ IHPME, University of Toronto, Toronto, Ontario, Canada.

Abstract

Background and aims: A 40% risk of disease recurrence post-liver transplantation (LT) for autoimmune hepatitis (AIH) has been previously reported. Risk factors for recurrence and its impact on long-term patient outcome are poorly defined. We aimed to assess prevalence, time to disease recurrence, as well as patient and graft survival in patients with recurrent AIH (rAIH) versus those without recurrence.

Methods: Single-center retrospective study of adult recipients who underwent LT for AIH between January 2007 and December 2017. Patients with AIH overlap syndromes were excluded.

Results: A total of 1436 LTs were performed during the study period, of whom 46 (3%) for AIH. Eight patients had AIH overlap syndromes and were excluded. Patients were followed up for 4.4 ± 3.4 years and mean age at LT was 46.8 years. Average transplant MELD (Model for End-Stage Liver Disease) score was 24.9. About 21% of patients (8 of 38) were transplanted for acute onset of AIH; 66% of patients (n = 25) received a deceased donor liver graft, and 34% a living donor organ. rAIH occurred in 7.8% (n = 3/38) of recipients. Time to recurrence was 1.6, 12.2 and 60.7 months. Patient and graft survival in patients without recurrence was 88.6% and 82.8% in 5 years, whereas in those with rAIH, it was 66.7%, respectively.

Conclusion: Although AIH recurs post-LT, our data indicate a lower recurrence rate when compared to the literature and excellent patient and graft survival.

Keywords: Autoimmune hepatitis; Liver transplantation; Recurrent autoimmune hepatitis.