Recurrence of autoimmune hepatitis in children after liver transplantation

Audrey H. Birnbaum, Keith J. Benkov, Nanci S. Pittman, Yvonne McFarlane-Ferreira, Joel Rosh, Neal S. LeLeiko

Research output: Contribution to journalArticle

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Abstract

Background: Liver transplantation is recognized as the appropriate treatment for end-stage liver disease due to chronic active autoimmune hepatitis. While it was initially thought that the disease did not recur after transplant, it is now generally accepted that adult patients may develop recurrent disease, with studies reporting a recurrence rate of ≤25%. We have noted a higher incidence of recurrent autoimmune hepatitis in our pediatric patients undergoing liver transplant, with a high incidence of associated morbidity. Methods: We reviewed the records of six children followed up for autoimmune hepatitis who underwent orthotopic liver transplant for complications of end-stage liver disease. Results: Of the six, five developed recurrent autoimmune hepatitis at a mean time of 11.4 months after transplant. The disease was aggressive, leading to cirrhosis and retransplant in three patients, within 1 year of recurrence. A second recurrence of disease occurred in all three retransplanted patients. One patient has received a third liver transplant, one has died, and one patient is asymptomatic on medical therapy. Autoimmune hepatitis recurred in all four patients receiving tacrolimus. Conclusion: We conclude that liver transplant for autoimmune hepatitis is likely to be palliative for most pediatric patients. Potent immunosuppressives such as tacrolimus do not protect against the development of recurrent autoimmune hepatitis.

Original languageEnglish (US)
Pages (from-to)20-25
Number of pages6
JournalJournal of pediatric gastroenterology and nutrition
Volume25
Issue number1
DOIs
StatePublished - Jul 1 1997

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Autoimmune Hepatitis
Liver Transplantation
Recurrence
Transplants
End Stage Liver Disease
Liver
Tacrolimus
Pediatrics
Incidence
Chronic Hepatitis
Immunosuppressive Agents
Fibrosis
Morbidity
Therapeutics

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology

Cite this

Birnbaum, Audrey H. ; Benkov, Keith J. ; Pittman, Nanci S. ; McFarlane-Ferreira, Yvonne ; Rosh, Joel ; LeLeiko, Neal S. / Recurrence of autoimmune hepatitis in children after liver transplantation. In: Journal of pediatric gastroenterology and nutrition. 1997 ; Vol. 25, No. 1. pp. 20-25.
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abstract = "Background: Liver transplantation is recognized as the appropriate treatment for end-stage liver disease due to chronic active autoimmune hepatitis. While it was initially thought that the disease did not recur after transplant, it is now generally accepted that adult patients may develop recurrent disease, with studies reporting a recurrence rate of ≤25{\%}. We have noted a higher incidence of recurrent autoimmune hepatitis in our pediatric patients undergoing liver transplant, with a high incidence of associated morbidity. Methods: We reviewed the records of six children followed up for autoimmune hepatitis who underwent orthotopic liver transplant for complications of end-stage liver disease. Results: Of the six, five developed recurrent autoimmune hepatitis at a mean time of 11.4 months after transplant. The disease was aggressive, leading to cirrhosis and retransplant in three patients, within 1 year of recurrence. A second recurrence of disease occurred in all three retransplanted patients. One patient has received a third liver transplant, one has died, and one patient is asymptomatic on medical therapy. Autoimmune hepatitis recurred in all four patients receiving tacrolimus. Conclusion: We conclude that liver transplant for autoimmune hepatitis is likely to be palliative for most pediatric patients. Potent immunosuppressives such as tacrolimus do not protect against the development of recurrent autoimmune hepatitis.",
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Recurrence of autoimmune hepatitis in children after liver transplantation. / Birnbaum, Audrey H.; Benkov, Keith J.; Pittman, Nanci S.; McFarlane-Ferreira, Yvonne; Rosh, Joel; LeLeiko, Neal S.

In: Journal of pediatric gastroenterology and nutrition, Vol. 25, No. 1, 01.07.1997, p. 20-25.

Research output: Contribution to journalArticle

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AU - Birnbaum, Audrey H.

AU - Benkov, Keith J.

AU - Pittman, Nanci S.

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AU - Rosh, Joel

AU - LeLeiko, Neal S.

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N2 - Background: Liver transplantation is recognized as the appropriate treatment for end-stage liver disease due to chronic active autoimmune hepatitis. While it was initially thought that the disease did not recur after transplant, it is now generally accepted that adult patients may develop recurrent disease, with studies reporting a recurrence rate of ≤25%. We have noted a higher incidence of recurrent autoimmune hepatitis in our pediatric patients undergoing liver transplant, with a high incidence of associated morbidity. Methods: We reviewed the records of six children followed up for autoimmune hepatitis who underwent orthotopic liver transplant for complications of end-stage liver disease. Results: Of the six, five developed recurrent autoimmune hepatitis at a mean time of 11.4 months after transplant. The disease was aggressive, leading to cirrhosis and retransplant in three patients, within 1 year of recurrence. A second recurrence of disease occurred in all three retransplanted patients. One patient has received a third liver transplant, one has died, and one patient is asymptomatic on medical therapy. Autoimmune hepatitis recurred in all four patients receiving tacrolimus. Conclusion: We conclude that liver transplant for autoimmune hepatitis is likely to be palliative for most pediatric patients. Potent immunosuppressives such as tacrolimus do not protect against the development of recurrent autoimmune hepatitis.

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