Recurrent and de novo autoimmune hepatitis.

Stirnimann, Guido; Ebadi, Maryam; Czaja, Albert J; Montano-Loza, Aldo J (2019). Recurrent and de novo autoimmune hepatitis. Liver transplantation, 25(1), pp. 152-166. Wiley 10.1002/lt.25375

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Clinical indications for liver transplantation (LT) in patients with autoimmune hepatitis (AIH) are identical to those of patients with other chronic liver diseases that end in acute or semi-acute liver failure, decompensated cirrhosis, or hepatocellular carcinoma. Recurrent disease after LT has been reported in 10-50% of patients with AIH, and the frequency of detection is influenced in part by the use of protocol or clinically indicated liver biopsy. De novo AIH connotes the development of AIH in patients transplanted for liver diseases other than AIH, and it has been reported in 5-10% of pediatric and 1-2% of adult recipients. Recurrent disease can negatively impact on graft and patient survival, and re-transplantation has been required in 8-23%. De novo AIH is within the spectrum of graft dysfunction that includes plasma cell-rich rejection, and it can also progress to cirrhosis and graft failure. Treatment for recurrent or de novo disease is based on the conventional regimens for AIH, and corticosteroid therapy alone or combined with azathioprine is standard. Better control of disease activity prior to LT has been associated with less recurrence, and maintenance corticosteroid treatment after LT can reduce its frequency. CONCLUSIONS: Recurrent AIH is far more frequent than de novo AIH. Both may have negative impacts on graft and patient survival, and early detection and treatment are key objectives. Future investigations must codify the diagnostic criteria for each graft dysfunction, seek diagnostic biomarkers, and evaluate treatments that improve outcomes without increasing the risk of pre- and post-LT infections. This article is protected by copyright. All rights reserved.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology

UniBE Contributor:

Stirnimann, Guido

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1527-6465

Publisher:

Wiley

Language:

English

Submitter:

Thi Thao Anh Pham

Date Deposited:

11 Dec 2018 16:50

Last Modified:

01 Nov 2019 02:31

Publisher DOI:

10.1002/lt.25375

PubMed ID:

30375180

Uncontrolled Keywords:

autoimmune liver disease graft survival liver transplantation recurrent disease survival

BORIS DOI:

10.7892/boris.122081

URI:

https://boris.unibe.ch/id/eprint/122081

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