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World J Transplant. Mar 18, 2022; 12(3): 59-64
Published online Mar 18, 2022. doi: 10.5500/wjt.v12.i3.59
Autoimmune hepatitis and liver transplantation: Indications, and recurrent and de novo autoimmune hepatitis
Murat Harputluoglu, Ali Riza Caliskan, Sami Akbulut
Murat Harputluoglu, Department of Gastroenterology and Transplant Hepatology, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Ali Riza Caliskan, Department of Gastroenterology, Adiyaman Education and Research Hospital, Adıyaman 04120, Turkey
Sami Akbulut, Liver Transplant Institute, Inonu University, Malatya 44280, Turkey
Author contributions: Harputluoglu M and Caliskan AR wrote manuscript; Harputluoglu M and Akbulut S projected development and reviewed final version.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sami Akbulut, MD, PhD, Professor, Liver Transplant Institute, Inonu University, Elazig Yolu 10. Km, Malatya 44280, Turkey. akbulutsami@gmail.com
Received: September 22, 2021
Peer-review started: September 22, 2021
First decision: October 27, 2021
Revised: November 15, 2021
Accepted: February 23, 2022
Article in press: February 23, 2022
Published online: March 18, 2022
Abstract

Autoimmune hepatitis is a chronic inflammatory disease of the liver that is characterized by circulating autoantibodies and elevated serum globulin levels. Liver transplantation may be required for patients with acute liver failure, decompensated cirrhosis, and hepatocellular carcinoma. Recurrence is defined as development of the same disease in the allograft following liver transplantation. Autoimmune hepatitis recurs in 36%-68% of the recipients 5 years after liver transplantation. De novo autoimmune hepatitis is the development of autoimmune hepatitis like clinical and laboratory characteristics in patients who had undergone liver transplantation for causes other than autoimmune hepatitis. Diagnostic work up for recurrent and de novo autoimmune hepatitis is similar to the diagnosis of the original disease, and it is usually difficult. Predniso(lo)ne with or without azathioprine is the main treatment for recurrent and de novo autoimmune hepatitis. Early diagnosis and treatment are vital for patient prognosis because de novo autoimmune hepatitis and recurrent autoimmune hepatitis cause graft loss and result in subsequent retransplantation if medical treatment fails.

Keywords: Liver transplantation, Autoimmune hepatitis, Recurrence autoimmune hepatitis, De novo autoimmune hepatitis

Core Tip: Autoimmune hepatitis is a chronic inflammatory disease of the liver that is characterized by circulating autoantibodies and elevated serum globulin levels. Liver transplantation may be required for patients with acute liver failure, decompensated cirrhosis, and hepatocellular carcinoma. De novo autoimmune hepatitis and recurrent autoimmune hepatitis are known causes of late graft dysfunction following liver transplantation which should be included in the differential diagnosis.