Recurrence of primary biliary cirrhosis, primary sclerosing cholangitis, and autoimmune hepatitis.

Thus, controversy remains as to whether PBC or PSC does recur in the allograft. Both diseases are of unknown origin. If PBC does recur in the allograft then, on current evidence, it is likely to recur only in a minority of patients at least in the short to medium term. Furthermore, recurrent does not appear to impact on patient or graft survival. As with chronic hepatitis B, the degree of immunosuppression may also affect the pattern and rate of disease recurrence. Sclerosing cholangitis does affect the graft, but the clinically severe form appears to be related to factors other than recurrent disease. The histological features of PSC are nondiagnostic but one study at least does suggest that, as with PBC, the pattern of disease recurrence is patchy and early in the medium term. Autoimmune hepatitis may recur but the patterns of recurrent disease are uncertain. If some of the reports do show recurrent disease, then it seems that recurrent disease is more aggressive in the allograft than in the native liver. Disease recurrence is of more academic and practical importance. Clinicians need to be aware of possible recurrence and, where appropriate, modify immunosuppression and interpret liver tests and histology appropriately. Finally, the patterns of recurrence may give useful clues to the pathogenesis of these enigmatic diseases.