Recurrence of autoimmune liver diseases after liver transplantation: Review and expert opinion statement

被引：5

作者：

Montano-Loza, Aldo J. ^{[1
,2
,15
,16
]}

Corpechot, Christophe ^{[3
,4
]}

Burra, Patrizia ^{[5
]}

Schramm, Christoph ^{[6
,7
]}

Selzner, Nazia ^{[8
]}

Ronca, Vincenzo ^{[9
,10
]}

Oo, Ye H. ^{[11
,12
,13
,14
]}

机构：

[1] Univ Alberta, Div Gastroenterol, Edmonton, AB, Canada

[2] Univ Alberta, Liver Unit, Edmonton, AB, Canada

[3] St Antoine Hosp, AP HP, Reference Ctr Inflammatory Biliary Dis & Autoimmun, European Reference Network Hepatol Dis ERN RARE LI, Paris, France

[4] Sorbonne Univ, St Antoine Res Ctr, Inserm, UMR S938, Paris, France

[5] Univ Padua, Dept Surg Oncol & Gastroenterol, European Reference Network Hepatol Dis ERN RARE LI, Padua, Italy

[6] Univ Med Ctr Hamburg Eppendorf, European Reference Network Hepatol Dis ERN RARE LI, Martin Zeitz Ctr Rare Dis, Hamburg, Germany

[7] Univ Med Ctr Hamburg Eppendorf, European Reference Network Hepatol Dis ERN RARE LI, Dept Med 1, Hamburg, Germany

[8] Univ Toronto, Toronto Gen Hosp, Ajmera Transplant Ctr, Toronto, ON, Canada

[9] Humanitas Univ, Dept Biomed Sci, Via Rita Levi Montalcini 4, I-20072 Pieve Emanuele, Italy

[10] IRCCS Humanitas Res Hosp, Via Manzoni 56, I-20089 Rozzano, Italy

[11] Univ Birmingham, Ctr Liver & Gastro Res, Birmingham, England

[12] Univ Birmingham, Natl Inst Hlth Res Birmingham Biomed Res Ctr, Birmingham, England

[13] Univ Hosp Birmingham NHS Fdn Trust, Ctr Rare Dis, Birmingham, England

[14] Univ Hosp Birmingham NHS Fdn Trust, ERN Rare Liver Ctr, Liver Transplant & Hepatobiliary Unit, Birmingham, England

[15] Univ Alberta, Zeidler Ledcor Ctr Edmonton, Div Gastroenterol, Med, 8540 112 St NW, Edmonton, AB T6G 2X8, Canada

[16] Zeidler Ledcor Ctr Edmonton, Liver Unit, 8540 112 St NW, Edmonton, AB T6G 2X8, Canada

来源：

LIVER TRANSPLANTATION | 2025年 / 31卷 / 03期

关键词：

Autoimmune hepatitis; primary biliary cholangitis; primary sclerosing cholangitis; liver transplantation; recurrent disease; PRIMARY SCLEROSING CHOLANGITIS; PRIMARY BILIARY-CIRRHOSIS; DUCT-TO-DUCT; RISK-FACTORS; ALKALINE-PHOSPHATASE; URSODEOXYCHOLIC ACID; HEPATITIS; OUTCOMES; IMPACT; IMMUNOSUPPRESSION;

D O I：

10.1097/LVT.0000000000000419

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Autoimmune liver diseases (AILD) constitute the fourth most common indication for liver transplantation (LT) across the world. In general, the outcomes after LT are acceptable, however, disease recurrence post-LT is common for all AILD which can negatively affect graft and overall survival. Several questions persist, including the risk factors associated with recurrent disease, optimal anti-rejection medications, strategies to reduce the risk of recurrence, and how to best incorporate these strategies into clinical practice. For that reason, we assembled an international group of experts to review evidence to address these outstanding questions regarding liver transplantation for AILD. Survival rates post-LT are approximately 90 and 70% at 1- and 5-years and recurrent disease occurs in 10 to 50% of patients with AILD. In patients with disease recurrence, graft survival decreased by 18% and 28% and overall survival by 8% and 12% at 5 and -10 years after LT, respectively. Recurrent AIH is associated with high aminotransferases and immunoglobulin G (IgG) before LT, lymphoplasmacytic infiltrates in the explants, and may be associated with the absence of steroids after LT. However, the efficiency and safety of triple immunosuppressive maintenance therapy is still debatable. Younger age at diagnosis with PBC or at LT are associated with PBC recurrence. Preventive use of ursodeoxycholic acid reduces the risk of recurrence and has a benefit in graft and patient survival. Episodes of systemic inflammation including T-cell mediated rejection, active ulcerative colitis and episodes of cholangitis are associated with recurrent PSC. Conclusions: Recurrent disease for AILD is associated with worse graft and patient survival. AIH patients could be considered for long-term low-dose predniso(lo)ne, whereas PBC patients should be placed on preventive UDCA after LT. There are no specific treatments for PSC recurrence; however, adequate control of inflammatory bowel disease and optimal immunosuppression to avoid T-cell-mediated rejection should be encouraged.

引用

页码：369 / 383

页数：15

共 75 条

[1] Improvement of serum alkaline phosphatase to <1.5 upper limit of normal predicts better outcome and reduced risk of cholangiocarcinoma in primary sclerosing cholangitis [J].