Premium
Risk factors for recurrence of autoimmune hepatitis after liver transplantation
Author(s) -
MontanoLoza Aldo J.,
Mason Andrew L.,
Ma Mang,
Bastiampillai Ravin J.,
Bain Vincent G.,
Tandon Puneeta
Publication year - 2009
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.21796
Subject(s) - medicine , autoimmune hepatitis , liver transplantation , gastroenterology , hazard ratio , hepatitis , transplantation , liver disease , univariate analysis , proportional hazards model , confidence interval , immunology , multivariate analysis
Autoimmune hepatitis has been reported to recur after liver transplantation. The aim of our study was to evaluate the risk factors associated with recurrence of autoimmune hepatitis. Forty‐six patients that underwent liver transplantation because of end‐stage liver disease secondary to autoimmune hepatitis were studied. Recurrence of autoimmune hepatitis was diagnosed in 11 of the 46 (24%) patients, and the overall 5‐year probability of recurrence was 18%. By univariate Cox analysis, the features before liver transplantation associated with a higher risk of recurrence were concomitant autoimmune disease [hazard ratio (HR), 3.74; 95% confidence interval (CI), 1.05–13.36; P = 0.04], high aspartate aminotransferase (HR, 1.09; 95% CI, 1.03–1.14; P = 0.002), high alanine aminotransferase (HR, 1.09; 95% CI, 1.03–1.20; P = 0.003), and high immunoglobulin G (IgG; HR, 1.25; 95% CI, 1.11–1.41; P = 0.0003). Moreover, patients with recurrence had a higher frequency of moderate to severe inflammatory activity (HR, 5.3; 95% CI, 1.55–18.79; P = 0.008) and plasma cell infiltration in the liver explant (HR, 5.8; 95% CI, 1.52–22.43; P = 0.01). In the multivariate Cox analysis, only the presence of moderate to severe inflammation (HR, 6.9; 95% CI, 1.76–26.96; P = 0.006) and high IgG levels before liver transplantation (HR, 7.5; 95% CI, 1.45–38.45; P = 0.02) were independently associated with the risk of autoimmune hepatitis recurrence. In conclusion, patients with concomitant autoimmune disease, high aspartate aminotransferase, alanine aminotransferase, and IgG before the transplant, or moderate to severe inflammatory activity or plasma cell infiltration in the liver explant have a higher risk of recurrent disease. These findings suggest that recurrence of autoimmune hepatitis may reflect incomplete suppression of disease activity prior to liver transplantation. Liver Transpl 15:1254–1261, 2009. © 2009 AASLD.