Histologic surveillance after liver transplantation due to autoimmune hepatitis

Background Autoimmune hepatitis ( AIH ) often recurs after liver transplantation ( LT ). Our aim was to evaluate the recurrence rate of AIH after LT , impact of AIH recurrence on survival and fibrosis progression, and find risk factors for AIH recurrence. Methods Forty‐two patients with AIH prior to LT with ≥1 protocol biopsy ≥1 year post‐ LT were included with a median follow‐up of 5.0 years (1.0‐17.0). Follow‐up liver biopsies were re‐evaluated for AIH recurrence, fibrosis progression, and cirrhosis development. Results A histological recurrence of AIH was diagnosed in 15 (36%) patients at a median of 5 years of follow‐up. Recurrent AIH lead to progressive fibrosis ( METAVIR stage 3‐4) in two but did not cause a single patient or graft loss. Transaminases were normal in three patients with recurrent AIH (20%). AIH recurrence was more common in patients with no overlapping cholangitis ( OR 1.44, P =.021). Immunosuppression without antimetabolite increased the risk of AIH recurrence ( OR 1.47, P =.018). Patient and graft survival rates at 1, 5, and 10 years were 94%, 86%, and 86% and 91%, 77%, and 74%. AIH recurrence did not affect survival. Conclusions AIH recurrence occurs in 36% in 5 years, but does not affect patient or graft outcome.