Montano-Loza Aldo J, Mason Andrew L, Ma Mang, Bastiampillai Ravin J, Bain Vincent G, Tandon Puneeta
Division of Gastroenterology and Liver Unit, University of Alberta Hospital, Edmonton, Alberta, Canada.
Liver Transpl. 2009 Oct;15(10):1254-61. doi: 10.1002/lt.21796.
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.
据报道，自身免疫性肝炎在肝移植后会复发。我们研究的目的是评估与自身免疫性肝炎复发相关的危险因素。对46例因自身免疫性肝炎继发终末期肝病而接受肝移植的患者进行了研究。46例患者中有11例（24%）被诊断为自身免疫性肝炎复发，总体复发的5年概率为18%。通过单因素Cox分析，肝移植前与较高复发风险相关的特征为合并自身免疫性疾病[风险比（HR），3.74；95%置信区间（CI），1.05 - 13.36；P = 0.04]、高天冬氨酸转氨酶（HR，1.09；95% CI，1.03 - 1.14；P = 0.002）、高丙氨酸转氨酶（HR，1.09；95% CI，1.03 - 1.20；P = 0.003）以及高免疫球蛋白G（IgG；HR，1.25；95% CI，1.11 - 1.41；P = 0.0003）。此外，复发患者中度至重度炎症活动的频率更高（HR，5.3；95% CI，1.55 - 18.79；P = 0.008），且肝外植体中有浆细胞浸润（HR，5.8；95% CI，1.52 - 22.43；P = 0.01）。在多因素Cox分析中，只有中度至重度炎症的存在（HR，6.9；95% CI，1.76 - 26.96；P = 0.006）以及肝移植前高IgG水平（HR，7.5；95% CI，1.45 - 38.45；P = 0.02）与自身免疫性肝炎复发风险独立相关。总之，合并自身免疫性疾病、移植前高天冬氨酸转氨酶、丙氨酸转氨酶和IgG水平，或肝外植体中存在中度至重度炎症活动或浆细胞浸润的患者复发疾病的风险更高。这些发现表明，自身免疫性肝炎的复发可能反映了肝移植前疾病活动未得到完全抑制。
