Recurrent primary biliary cirrhosis, primary sclerosing cholangitis, and autoimmune hepatitis after transplantation

Authors

  • Thomas W. Faust MD

    Corresponding author
    1. From the Liver Study Unit, Section of Gastroenterology, Department of Medicine, The University of Chicago Hospitals and Clinics, University of Chicago, IL
    • Liver Study Unit, Section of Gastroenterology, Department of Medicine, The University of Chicago Hospitals and Clinics, The University of Chicago, 5841 S Maryland Ave, MC4076, Chicago, IL 60637. Telephone: 773-702-2396; FAX: 773-834-1288
    Search for more papers by this author

Abstract

Key Points

  • 1Recurrent primary biliary cirrhosis (PBC) after transplantation is controversial, but most studies support disease recurrence within the graft.
  • 2Granulomatous destructive cholangitis should be present, and exclusion of acute and chronic rejection, graft-versus-host disease, biliary obstruction, viral hepatitis, and drug effects is mandatory before making a diagnosis of recurrent PBC.
  • 3Recurrent primary sclerosing cholangitis (PSC) after transplantation is difficult to diagnose because of the lack of a diagnostic gold standard.
  • 4Well-defined cholangiographic and histological criteria should be present, and exclusion of preservation injury, blood group type incompatibility between donor and recipient, chronic rejection, hepatic arterial occlusion, and viral infection is mandatory before making a diagnosis of recurrent PSC.
  • 5Most studies support recurrent autoimmune hepatitis (AIH) after transplantation based on clinical, biochemical, serological, and histological criteria. Exclusion of rejection, viral infection, drug effects, and biliary obstruction is mandatory before making a diagnosis of recurrent AIH.
  • 6Intermediate-term patient and graft survival are excellent for patients with recurrent autoimmune liver diseases within the transplanted liver, but additional studies are required to address the impact of disease recurrence on long-term patient and graft survival.

Ancillary