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Corticosteroids reduce autoimmune hepatitis recurrence post-transplant

Long-term corticosteroid use reduces autoimmune hepatitis recurrence after liver transplantation, according to published findings in Liver Transplantation. 

Researchers conducted a retrospective chart review of 73 patients who underwent liver transplant due to autoimmune hepatitis (AIH) between January 1999 and October 2014 in a single center, and who survived more than 6 months post-transplant. Of the patients, 69 were on a triple immunosuppression regimen post-transplant and were included in the final analysis.

The goal of the study was to determine the effects of corticosteroid therapy on recurrence of AIH, overall survival, and therapy-related complications such as sepsis and osteoporosis, post-transplant, according to the research. The majority of patients were on corticosteroid therapy (prednisolone) until the end of the study period (86%). The median follow-up was 94 months.

Using Kaplan-Meier survival analysis, the overall survival and regraft-free survival rates were 92% and 86% at 1 year, 90% and 81% at 3 years, 86% and 78% at 5 years and 73% and 64% at 10 years post-transplant. Only five patients developed AIH recurrence and all had high immunoglobulin G levels at the time. Recurrence was diagnosed at 18, 19, 48, 60 and 88 months post-transplant, indicating recurrence rates of 0% at 1 year, 4% at 3 years, 6% at 5 years and 11% at 10 years post-transplant.

Thirty-three episodes of sepsis occurred 6 months or more post-transplant in 33% of patients (n = 22). The most common recurrent infections were gastroenteritis and cholangitis, but in a small group of patients. However, pneumonia was the most common infection and four of five deaths occurred as a result of sepsis. Fifteen patients developed osteoporosis, with only one having to stop corticosteroid use due to the development of stress fracture. Freedom from sepsis was 91% at 1 year, 82% at 3 years, 80% at 5 years and 63% at 10 years post-transplant, whereas freedom from osteoporosis was 100% at 1 year, 94% at 3 years, 82% at 5 years and 58% at 10 years post-transplant.

“Long-term low-dose corticosteroids in combination with other immunosuppressive agents seem to reduce AIH recurrence without jeopardizing patient and graft survival,” the researchers concluded. – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.