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Liver Transplantation for Autoimmune Hepatitis

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Autoimmune Hepatitis

Part of the book series: Clinical Gastroenterology ((CG))

Abstract

Indications for liver transplantation include end-stage liver failure (as suggested by a MELD score ≥16), the development of liver cancer that is not amenable to other treatments, intractable symptoms that make the patient’s life intolerable (such as intractable encephalopathy). Some patients who present with fulminant AIH may also be suitable liver transplant candidates. Currently, 10-year survival exceeds 70%.

Recurrent AIH (rAIH) develops in approximately one-third of recipients and may be first detected more than 10 years after transplantation. Distinguishing between rejection, recurrent AIH, and some other causes of graft damage can be difficult. The diagnosis of rAIH is made on typical serology and histology; treatment is with the addition or increase in corticosteroids and is often successful in controlling disease progression although some may progress to graft failure despite increased treatment.

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Abbreviations

AIH:

Autoimmune hepatitis

ANA:

Anti-nuclear antibodies

ASM:

Anti-smooth muscle antibodies

AST:

Aspartate aminotransferase

CNI:

Calcineurin inhibitor

GSTT1:

Glutathione S-transferase T1

HCC:

Liver cell cancer(hepatocellular carcinoma)

HCV:

Hepatitis C virus

HLA:

Human leucocyte antigen

IgG:

Immunoglobulin G

INR:

International normalised ratio

LKM:

Liver-kidney microsomal antibody

MELD:

Model for end-stage liver disease

MMF:

Mycophenolate mofetil

OLT:

Orthotopic liver transplant

PBC:

Primary biliary cirrhosis

PEI:

Percutaneous ethanol injection

PT:

Prothrombin time

PTLD:

Post-transplant lymphoproliferative disease

rAIH:

Recurrent AIH

RFA:

Radiofrequency ablation

TACE:

Trans-arterial chemo-embolisation

TIPS:

Transjugular intra-hepatic shunt

TMPT:

Thiopurine methyl transferase

UKELD:

United Kingdom model for end-stage liver disease

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Authors and Affiliations

  1. Liver Unit, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK

    James Neuberger

  2. NHS Blood and Transplant, Directorate for Organ Donation and Transplantation, Fox Den Road, Bristol, UK

    James Neuberger

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  1. James Neuberger
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Correspondence to James Neuberger .

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Editors and Affiliations

  1. Toronto Western Hospital Liver Centre, Department of Medicine, University of Toronto, Bathhurst St. 399, Toronto, M5T 2S8, Ontario, Canada

    Gideon M. Hirschfield

  2. Toronto Western Hospital Liver Centre, University of Toronto, Bathhurst St. 399, Toronto, M5T 2S8, Ontario, Canada

    E. Jenny Heathcote

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Neuberger, J. (2012). Liver Transplantation for Autoimmune Hepatitis. In: Hirschfield, G., Heathcote, E. (eds) Autoimmune Hepatitis. Clinical Gastroenterology. Springer, New York, NY. https://doi.org/10.1007/978-1-60761-569-9_9

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  • DOI: https://doi.org/10.1007/978-1-60761-569-9_9

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