Transplant Department, Guillermo Almenara I. National Hospital, ESSALUD, Lima, Peru.
Ann Hepatol. 2012 Mar-Apr;11(2):222-7.
Liver transplantation is the only therapy for end-stage liver disease. Cirrhosis secondary to autoimmune hepatitis (AIH) is an indication in 4-6% of adult transplants.
To describe the outcomes and recurrence of AIH in liver transplant patients.
Twenty patients were retrospectively studied.
The female/male ratio was 3:1, the median age was 36.7 years (range, 16 to 39 years), and the median MELD score was 18.5. According to serological analysis, 19 patients were AIH type 1 and one patient was AIH type 2. AIH was associated with human leukocyte antigen (HLA) DR13+ and DR4+. The overall 5-year patient and graft survival rates were 94 and 85%, respectively. Three (15.7%) cases of recurrent AIH were diagnosed based on histological evidence. Clinical and histological features of acute and chronic rejection were present in four (20%) and three (16.6%) patients, respectively.
AIH frequently affected young women, was the most frequent indication for liver transplantation. Rejection and recurrence were commonly associated with AIH, but did not affect patient survival. No significant relationship between HLA-DR type and recurrence was found. Rapid progression to cirrhosis should be considered in severe recurrences.
肝移植是治疗终末期肝病的唯一方法。自身免疫性肝炎（AIH）引起的肝硬化是成人肝移植的 4-6%的适应证。
描述肝移植患者 AIH 的结局和复发情况。
回顾性研究了 20 例患者。
男女比例为 3:1，中位年龄为 36.7 岁（范围 16 至 39 岁），中位 MELD 评分为 18.5。根据血清学分析，19 例为 AIH 1 型，1 例为 AIH 2 型。AIH 与人类白细胞抗原（HLA）DR13+和 DR4+相关。总体 5 年患者和移植物存活率分别为 94%和 85%。根据组织学证据诊断出 3 例（15.7%）复发性 AIH。4 例（20%）和 3 例（16.6%）患者分别存在急性和慢性排斥的临床和组织学特征。
AIH 常影响年轻女性，是肝移植最常见的适应证。排斥和复发常与 AIH 相关，但不影响患者生存。未发现 HLA-DR 类型与复发之间存在显著关系。严重复发时应考虑迅速进展为肝硬化。
