Clinical Characteristics and Treatment Outcomes of Autoimmune-Like Hepatitis After Allogeneic Hematopoietic Stem Cell...

Liver dysfunction is a frequent complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). It may occur in both the early and late post-transplantation phases, with distinct etiologies. Chronic graft-versus-host disease is a well-known cause of late-onset liver dysfunction; however, other etiologies should also be considered. Among them, autoimmune-like hepatitis (AILH) is a rare but clinically significant complication.

We aimed to analyze patients who developed AILH after allo-HSCT to determine its incidence, clinical features, histological findings, and responses to treatment.

We retrospectively reviewed 228 consecutive patients who underwent their first allo-HSCT without treatment failure by day 100 after allo-HSCT at our institution between April 2013 and December 2024. The cumulative incidence of liver injury after allo-HSCT was calculated using a competing risk model that included death, relapse, and a second transplantation due to graft failure as competing events.

Among the study patients, 75 developed liver injury. The cumulative incidence rates of liver injury were 28.6% at 1 year and 32.6% at 2 years. A liver biopsy was performed in 13 patients, and eight met the pathological criteria for AILH. In patients diagnosed with AILH, the median age at allo-HSCT was 57 years, and the median onset of AILH was 300 days after allo-HSCT. Prednisolone (PSL) was administered to six of eight patients. All patients, including those who did not receive PSL, achieved a response, defined as an improvement in all liver enzymes, at a median of 28.5 days.

AILH is a rare but distinct form of liver injury that tends to occur in the late post-transplantation phase and shows an excellent response to corticosteroids.