Transplantation in autoimmune liver diseases

Table 1 Criteria for the diagnosis of recurrent AIH

Criteria
Liver transplant for autoimmune hepatitis
Auto-antibodies in significant titre (> 1:40)
Sustained rise in serum aminotransferase activity (> 2 times normal)
Elevated serum immunoglobulins
Compatible liver histology (infiltration of portal tracts by plasma cells, piecemeal necrosis and bridging necrosis[21])
Corticosteroid dependency
Exclusion of other causes of graft dysfunction (such as rejection and HCV infection)

Table 2 Reports of recurrent autoimmune hepatitis

Author	Follow up (mo)	n	Recurrence	Period recurrence occurred	Re-OLT/Cirrhosis
Milkiewicz 1999[23]	29	47	13/47	29 mo	3/47
Ayata 2000[24]	67	12	5/12	35-280 d	2/12
Reich 2000[15]	27	24	6/12	At 15 mo	3/24
Molmenti 2002[18]	29	55	11/55	At end
Duclos-Vallee2003[25]	120	17	7/17	2.5 yr1	2/17
Núñez-Martínez 2003[26]	38	15	1/15	At end
Vogel 2004[27]	24	28	9/28	5 yr	4/28
Gautam 2006[21]			23%	2.4 mo2

¹Mean;

²Median.

Table 3 Indications for transplantation in PBC

Indications
Symptom based
Intractable pruritus refractory to medical therapy
Hepatic encephalopathy
End-stage liver disease
Recurrent variceal haemorrhage
Episode of spontaneous bacterial peritonitis
Pulmonary hypertension
Hepato-pulmonary syndrome
Diuretic resistant ascites
Progressive osteopaenia
Muscle-wasting
Hepatoma (Milan criteria)
Biochemistry
Serum bilirubin > 150 &mgr;mol/L
Serum albumin < 25 g/L

Table 4 Criteria for the diagnosis of recurrent PBC

Criteria
Transplantation for PBC
Characteristic histological features of PBC
Mononuclear inflammatory infiltrates
Lymphoid aggregates
Epithelioid granulomas
Bile duct damage
Persistence of anti-mitochondrial antibodies
Elevated immunoglobulins
Exclusion of other causes of graft damage

Definite recurrent PBC is made when all 4 of these criteria are present, and in the presence of at least 3 of the 4 histological features. Probable recurrence when only 2 histological features are present[40].

Table 5 Criteria for the diagnosis of recurrent primary sclerosing cholangitis[72]

Criteria
Transplant for PSC
Multiple non-anastomotic strictures, headings and irregularity more than 90 d post OLT
Characteristic liver histology (fibrous cholangitis and/or fibro-obliterative lesions) with or without ductopenia, biliary fibrosis or biliary cirrhosis may be seen (but absence of characteristic features does not exclude the diagnosis).
Exclusion of other causes of secondary sclerosing cholangitis & stricturing (due to surgery, trauma, ischaemia, hepatic artery stenosis/thrombosis, established ductopaenic rejection, blood type ABO incompatibility and infections)
Cholestatic liver tests