Fellow in Hepatology and Liver Transplantation, Liver Center, Baylor College of Medicine and St. Luke's Episcopal Hospital, 1709 Dryden, Suite 1500, Houston, TX 77030, USA.
Best Pract Res Clin Gastroenterol. 2011 Dec;25(6):765-82. doi: 10.1016/j.bpg.2011.09.008.
Liver transplantation is indicated for terminal phases of autoimmune hepatitis, primary biliary cirrhosis and primary sclerosing cholangitis. Indications for transplantation in autoimmune liver diseases are similar to those used in other acute or chronic liver diseases. Therapeutic advances have reduced the need for transplantation for autoimmune hepatitis and primary biliary cirrhosis but not for primary sclerosing cholangitis. Overall, outcomes of transplantation for autoimmune liver diseases are excellent. However, recurrence of autoimmune liver diseases in the allograft has variable impacts on graft and patient survivals. Treatment of recurrent diseases requires changes in immunosuppression or addition of ursodeoxycholic acid. Among autoimmune liver diseases, only autoimmune hepatitis occurs de novo in recipients transplanted for other diseases. Patients transplanted for autoimmune hepatitis or primary sclerosing cholangitis are at risk for reactivation or de novo onset of ulcerative colitis. Better understanding of the pathogenesis of recurrent autoimmune liver diseases is needed to devise effective means of prevention and treatment.
肝移植适用于自身免疫性肝炎、原发性胆汁性肝硬化和原发性硬化性胆管炎的终末期。自身免疫性肝病的移植适应证与其他急性或慢性肝病相似。治疗进展减少了对自身免疫性肝炎和原发性胆汁性肝硬化的移植需求，但对原发性硬化性胆管炎仍有需求。总体而言，自身免疫性肝病的移植结局非常好。然而，移植物中自身免疫性肝病的复发对移植物和患者的存活率有不同的影响。复发性疾病的治疗需要改变免疫抑制或添加熊去氧胆酸。在自身免疫性肝病中，只有自身免疫性肝炎在因其他疾病接受移植的受者中是新发病例。因自身免疫性肝炎或原发性硬化性胆管炎接受移植的患者有溃疡性结肠炎复发或新发的风险。需要更好地了解复发性自身免疫性肝病的发病机制，以制定有效的预防和治疗方法。
