Recurrent autoimmune hepatitis after liver transplantation impacts graft, overall survival

Recurrent autoimmune hepatitis after liver transplantation affected graft and overall survival, according to a presentation at the International Liver Congress.

“Recurrent autoimmune hepatitis following liver transplantation is clinically meaningful and associates with younger age at transplant, use of mycophenolate mofetil as immunosuppression after transplant, [sex] mismatch and higher immunoglobulin G after transplant,” Aldo J. Montano-Loza, MD, MSc, PhD, from the division of gastroenterology and liver unit, University of Alberta, Canada, said during his presentation. “Recurrent disease impacts graft and overall survival, highlighting the need for improvement in management strategies.”

Montano-Loza and colleagues included 736 patients with autoimmune hepatitis who underwent liver transplantation from January 1987 to June 2020 from 33 centers in North America, South America, Europe and Asia. Investigators identified patients with a higher risk for recurrence of autoimmune hepatitis based on histological diagnosis by assessing clinical data before and after liver transplantation, biochemical data within the first 12 months after liver transplantation, and immunosuppression after LT. They used Semi-Markov models to calculate cumulative probabilities of graft and overall survival after liver transplantation.

Results showed after 5 years, autoimmune hepatitis reoccurred in 20% of patents and in 31% after 10 years. Factors correlated with a higher risk for autoimmune hepatitis recurrence after adjusting for age at diagnosis, concomitant autoimmune disease, use of tacrolimus, cyclosporine, azathioprine, rejection episodes, living related autoimmune hepatitis, Roux-en-Y bile duct anastomosis, bilirubin at 6-month, ALT at 6- and 12-month, were age 42 years or younger at LT (HR = 3.01; 95% CI, 1.15–7.89;), use of mycophenolate mofetil post-LT (HR = 3.22; 95% CI, 1.4–7.41), donor and recipient sex mismatch (HR = 2.68; 95% CI, 1.42–5.06) and higher IgG pre-LT (HR = 1.03; 95% CI, 1.01–1.06).

Montano-Loza and colleagues noted recurrent autoimmune hepatitis correlated with graft loss (HR = 9.63; 95% CI, 4.73–19.61) and death (HR = 2.09; 95% CI, 1.09–3.99) after adjusting for confounders in multivariate Cox regression with time dependent covariate. Among patients with recurrent autoimmune hepatitis, the 5-, 10-, 15- and 20-year probability of graft survival was 78%, 65%, 53% and 53%, respectively, and 96%, 93%, 93%, and 87%, respectively in patients without recurrence.

According to researchers, the probability of overall survival was 81%, 73%, 55%, and 44% in patients with recurrence, and 93%, 81%, 75%, and 61% in patients without recurrence.

(P < .001).

“In Cox regression analysis, clinically driven liver biopsies were associated with a higher risk of recurrent autoimmune hepatitis and the may be related to the fact that patients with autoimmune hepatitis had a higher frequency of abnormal liver function tests,” Montano-Loza said. “Moreover, the mean time for recurrent autoimmune hepatitis was also different between centers that performed protocol and clinically driven biopsies.”