Autoimmune hepatitis surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

Overview

Liver transplantation is indicated when medical therapy fails, decompensated chronic liver disease, fulminant hepatic failure, hepatocellular carcinoma and MELD score of >15 or a Child-Pugh score of >10277. If AIH recurs after liver transplanation, Reintroduction of corticosteroids and azathioprine is usually given.

Surgery

Liver Transplantation

Liver transplantation is indicated in the following condition:^[1]^[2]^[3]

Medical therapy fails
Decompensated chronic liver disease
Fulminant hepatic failure
Hepatocellular carcinoma
MELD score of >15 or a Child-Pugh score of >10277

For more information about liver transplantation click here.

‘De novo’ AIH following liver transplantation

AIH can recur in the transplanted liver. Two patterns of disease are described:^[4]^[5]^[6]^[7]

First, who has detectable anti-LKM1 antibodies at high titer in combination with a serum AST level >500 IU/l,
Second associated with the presence of ANA or ASMA at lower titers (>1:80) and lower AST levels.

Treatment:

Reintroduction of corticosteroids and azathioprine.

References

↑ Reich DJ, Fiel I, Guarrera JV, Emre S, Guy SR, Schwartz ME, Miller CM, Sheiner PA (2000). “Liver transplantation for autoimmune hepatitis”. Hepatology. 32 (4 Pt 1): 693–700. doi:10.1053/jhep.2000.16666. PMID 11003612.
↑ Ahmed M, Mutimer D, Hathaway M, Hubscher S, McMaster P, Elias E (1997). “Liver transplantation for autoimmune hepatitis: a 12-year experience”. Transplant. Proc. 29 (1–2): 496. PMID 9123100.
↑ Khalaf H, Mourad W, El-Sheikh Y, Abdo A, Helmy A, Medhat Y, Al-Sofayan M, Al-Sagheir M, Al-Sebayel M (2007). “Liver transplantation for autoimmune hepatitis: a single-center experience”. Transplant. Proc. 39 (4): 1166–70. doi:10.1016/j.transproceed.2007.02.030. PMID 17524922.
↑ Ratziu V, Samuel D, Sebagh M, Farges O, Saliba F, Ichai P, Farahmand H, Gigou M, Féray C, Reynès M, Bismuth H (1999). “Long-term follow-up after liver transplantation for autoimmune hepatitis: evidence of recurrence of primary disease”. J. Hepatol. 30 (1): 131–41. PMID 9927160.
↑ Milkiewicz P, Hubscher SG, Skiba G, Hathaway M, Elias E (1999). “Recurrence of autoimmune hepatitis after liver transplantation”. Transplantation. 68 (2): 253–6. PMID 10440397.
↑ Prados E, Cuervas-Mons V, de la Mata M, Fraga E, Rimola A, Prieto M, Clemente G, Vicente E, Casanovas T, Fabrega E (1998). “Outcome of autoimmune hepatitis after liver transplantation”. Transplantation. 66 (12): 1645–50. PMID 9884253.
↑ Kerkar N, Hadzić N, Davies ET, Portmann B, Donaldson PT, Rela M, Heaton ND, Vergani D, Mieli-Vergani G (1998). “De-novo autoimmune hepatitis after liver transplantation”. Lancet. 351 (9100): 409–13. doi:10.1016/S0140-6736(97)06478-7. PMID 9482295.

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[pmid11003612-1] Reich DJ, Fiel I, Guarrera JV, Emre S, Guy SR, Schwartz ME, Miller CM, Sheiner PA (2000). “Liver transplantation for autoimmune hepatitis”. Hepatology. 32 (4 Pt 1): 693–700. doi:10.1053/jhep.2000.16666. PMID 11003612.

[pmid9123100-2] Ahmed M, Mutimer D, Hathaway M, Hubscher S, McMaster P, Elias E (1997). “Liver transplantation for autoimmune hepatitis: a 12-year experience”. Transplant. Proc. 29 (1–2): 496. PMID 9123100.

[pmid17524922-3] Khalaf H, Mourad W, El-Sheikh Y, Abdo A, Helmy A, Medhat Y, Al-Sofayan M, Al-Sagheir M, Al-Sebayel M (2007). “Liver transplantation for autoimmune hepatitis: a single-center experience”. Transplant. Proc. 39 (4): 1166–70. doi:10.1016/j.transproceed.2007.02.030. PMID 17524922.

[pmid9927160-4] Ratziu V, Samuel D, Sebagh M, Farges O, Saliba F, Ichai P, Farahmand H, Gigou M, Féray C, Reynès M, Bismuth H (1999). “Long-term follow-up after liver transplantation for autoimmune hepatitis: evidence of recurrence of primary disease”. J. Hepatol. 30 (1): 131–41. PMID 9927160.

[pmid10440397-5] Milkiewicz P, Hubscher SG, Skiba G, Hathaway M, Elias E (1999). “Recurrence of autoimmune hepatitis after liver transplantation”. Transplantation. 68 (2): 253–6. PMID 10440397.

[pmid9884253-6] Prados E, Cuervas-Mons V, de la Mata M, Fraga E, Rimola A, Prieto M, Clemente G, Vicente E, Casanovas T, Fabrega E (1998). “Outcome of autoimmune hepatitis after liver transplantation”. Transplantation. 66 (12): 1645–50. PMID 9884253.

[pmid9482295-7] Kerkar N, Hadzić N, Davies ET, Portmann B, Donaldson PT, Rela M, Heaton ND, Vergani D, Mieli-Vergani G (1998). “De-novo autoimmune hepatitis after liver transplantation”. Lancet. 351 (9100): 409–13. doi:10.1016/S0140-6736(97)06478-7. PMID 9482295.

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