Liver transplantation in autoimmune liver diseases

Liver transplantation is indicated for terminal phases of autoimmune hepatitis, primary biliary cirrhosis and primary sclerosing cholangitis. Indications for transplantation in autoimmune liver diseases are similar to those used in other acute or chronic liver diseases. Therapeutic advances have red...

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Bibliographic Details
Published in:Baillière's best practice & research. Clinical gastroenterology 2011-12, Vol.25 (6), p.765-782
Main Authors: Ilyas, Jawad A., MD, MS, O’Mahony, Christine A., MD, Vierling, John M., MD
Format: Article
Language:English
Subjects:
Autoimmune diseases
Autoimmune hepatitis
Cholangitis, Sclerosing - complications
Cholangitis, Sclerosing - surgery
Cholestatic liver diseases
Colitis, Ulcerative - complications
Disease
Gastroenterology and Hepatology
Hepatitis, Autoimmune - complications
Hepatitis, Autoimmune - surgery
Humans
Immunosuppression
Inflammatory bowel disease
Liver cancer
Liver cirrhosis
Liver Cirrhosis, Biliary - surgery
Liver diseases
Liver Transplantation
Lymphocytes
Mortality
Outcomes
Pathogenesis
Primary biliary cirrhosis
Primary sclerosing cholangitis
Recurrence
Steroids
Transplants & implants
Treatment Outcome
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Summary:Liver transplantation is indicated for terminal phases of autoimmune hepatitis, primary biliary cirrhosis and primary sclerosing cholangitis. Indications for transplantation in autoimmune liver diseases are similar to those used in other acute or chronic liver diseases. Therapeutic advances have reduced the need for transplantation for autoimmune hepatitis and primary biliary cirrhosis but not for primary sclerosing cholangitis. Overall, outcomes of transplantation for autoimmune liver diseases are excellent. However, recurrence of autoimmune liver diseases in the allograft has variable impacts on graft and patient survivals. Treatment of recurrent diseases requires changes in immunosuppression or addition of ursodeoxycholic acid. Among autoimmune liver diseases, only autoimmune hepatitis occurs de novo in recipients transplanted for other diseases. Patients transplanted for autoimmune hepatitis or primary sclerosing cholangitis are at risk for reactivation or de novo onset of ulcerative colitis. Better understanding of the pathogenesis of recurrent autoimmune liver diseases is needed to devise effective means of prevention and treatment.
ISSN:1521-6918
1532-1916
DOI:10.1016/j.bpg.2011.09.008