Incidence and risk factors associated with de novo autoimmune hepatitis after liver transplantation

Authors


  • Presented in part at the meeting of the American Association for the Study of Liver Diseases, November 1, 2009, Boston, Massachusetts.

Correspondence

Aldo J. Montano-Loza, MD, Zeidler Ledcor Centre, 130 University Campus, University of Alberta, Edmonton, AB, T6G 2X8, Canada

Tel: +(780) 248 1892

Fax: +(780) 248 1895

e-mail: aldomontano-loza@ualberta.ca

Abstract

Background/Aims

De novo autoimmune hepatitis (AIH) describes the development of hepatitis with autoimmune features in liver transplant (LT) patients without prior diagnosis of AIH. We aimed to evaluate the incidence and risk factors for de novo AIH.

Methods

A cohort of 576 patients with LT for aetiologies other than AIH was evaluated.

Results

De novo AIH was diagnosed in 17 patients (3%) with an overall incidence of 4.0 cases per 1000 patient-years. By univariate Cox analysis, patients who received cyclosporine A had lower risk (HR 0.24, 95% CI 0.07–0.80, P = 0.02), whereas patients who had female donors (HR 3.03, 95% CI 1.11–8.25, P = 0.03), donors ≥40-years (HR 6.95, 95% CI 1.93–25.03, P = 0.003), and those who received tacrolimus (HR 4.39, 95% CI 1.47–13.13, P = 0.008) and mycophenolate mofetil (HR 6.37, 95% CI 1.62–25.13, P = 0.008) had higher risk. Survival was similar in patients with de novo AIH compared with the LT population (mean survival time, 17 ± 1.5 vs. 16 ± 0.5 years, Log-rank test; P = 0.4).

Conclusions

The incidence of de novo AIH is low and does not impact on long-term survival. Recipients of female or older donor grafts, or recipients using tacrolimus, or mycophenolate mofetil as part of their immunosuppressive regimen have a higher risk of de novo AIH, whereas LT recipients maintained on cyclosporine A have a lower risk.

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