De novo autoimmune hepatitis in liver transplant: State-of-the-art review

Table 1 Differential features of de novo autoimmune hepatitis from other resembling etiologies of late graft dysfunction[1,2,7,8,58]

	de novo AIH	HCV recurrence	Acute rejection	Chronic rejection
Laboratory onset	HBV/HCV/HIV/CMV/EBV negative	HCV-RNA positive	Transaminases elevation	Transaminases normal/slightly increased
	Moderate liver enzymes increase	Low-moderate liver enzymes increase	Immunosuppressants levels under protective limits	Immunosuppressants levels under protective limits
	High IgG concentrations	ANA frequently positive	Autoantibodies negative or mild positive	Autoantibodies negative/mild positive
	Positivity for ANA, SMA, LKM, atypical LKM (anti-GSTT1), and/or AMA	SMA, AMA, LKM rarely positive
Clinical presentation	Onset variable from indolent to overt, may follow an antiviral treatment for HCV recurrence, especially when viral clearance is obtained	Gradual progression to cirrhosis except severe forms	Rapidly progressive deterioration of liver function scores	Silent onset
				Slow progression to deterioration of liver function scores
	IAHG probable/definite diagnosis
Histology	Portal tract infiltrate rich in plasma-cells	Chronic logistic infiltrate	Central perivenulitis	Biliary inflammatory and ischemic pattern: bile ductopenia and inflammation, artheriolar/capillary obliterative features or loss
	Interface hepatitis	Possible interface hepatitis	Hepatic venous endothelitis
	Rosette	Confluent/bridging necrosis	Mononuclear/mixed portal infiltrate
	Lobular inflammation ± bridging/confluent necrotic foci	Progression to cirrhosis
		Possible fibrosing cholestatic hepatitis	Bile ducts inflammation
Treatment	Prednis(ol)one ± MMF/azathioprine	Antiviral treatment	Steroids bolus	Steroids bolus
		Immunosuppression levels monitoring	Adjustment of immunosuppressive regimen	Switch to/addition of a new immunosuppressant and/or optimization of current regimen)

AIH: Autoimmune hepatitis; HBV: Hepatitis B virus; HCV: Hepatitis C virus; HIV: Human immunodeficiency virus; CMV: Cytomegalovirus; EBV: Epstein-Barr virus; ANA: Antinuclear antibody; SMA: Smooth muscle antibody; LKM: Liver kidney-microsomal antibody; GSTT1: Glutathione S-transferase T1; AMA: Anti-mitochondrial antibody; IAHG: International autoimmune hepatitis group; MMF: Mycophenolate mofetil.