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Reduced Complications after Arterial Reconnection in a Rat Model of Orthotopic Liver Transplantation
Published on: November 7, 2020
Liver transplantation for autoimmune hepatitis: a single-center experience
H Khalaf1, W Mourad, Y El-Sheikh
1Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. hatem_khalaf@hotmail.com
Liver transplantation (LT) for autoimmune hepatitis (AIH) demonstrates excellent survival rates, with patients typically being young women requiring long-term steroids. Steroid withdrawal often leads to disease recurrence, highlighting the need for careful immunosuppression management in AIH patients undergoing LT.
Area of Science:
- Hepatology
- Transplant Surgery
- Immunology
Background:
- Autoimmune hepatitis (AIH) is a chronic liver disease.
- Liver transplantation (LT) is a treatment option for end-stage liver disease due to AIH.
- Both deceased donor liver transplantation (DDLT) and living-donor liver transplantation (LDLT) can be utilized.
Purpose of the Study:
- To evaluate the outcomes of DDLT and LDLT in patients with AIH.
- To analyze patient and graft survival rates after LT for AIH.
- To identify specific challenges and complications associated with LT for AIH.
Main Methods:
- A retrospective review of 116 LT procedures (73 DDLT, 43 LDLT) between 2001 and 2006.
- Analysis of 16 patients transplanted for AIH, receiving FK506- and steroid-based immunosuppression.
- Assessment of patient demographics, MELD scores, surgical complications, survival rates, disease recurrence, and tumor marker levels.
Main Results:
- Overall patient and graft survival rates were 93.8% after a median follow-up of 530 days.
- Four DDLTs required arterial reconstruction due to steroid-induced angiopathy.
- Histopathologic recurrence occurred in 18.7% of patients, managed by optimizing immunosuppression. Elevated CA19-9 levels were observed in 28% of patients without malignancy. Steroid withdrawal failed in all recipients.
Conclusions:
- LT for AIH yields excellent long-term outcomes.
- AIH patients undergoing LT are typically young women with high MELD scores.
- Long-term steroid use is often necessary to prevent rejection and recurrence; steroid withdrawal can precipitate disease flares. Elevated CA19-9 and hepatic artery angiopathy are potential complications.
