Recurrence of autoimmune liver diseases after liver transplantation

Table 1 Mayo clinic criteria for recurrent primary sclerosing cholangitis after liver transplantation[12]

Inclusion criteria

Confirmed diagnosis of PSC before LT

Cholangiography showing non-anastomotic intra- and/or extra- hepatic biliary strictures with beading and irregularities of bile ducts at least 90 d after LT and/or

Histopathological findings of fibrous cholangitis and/or fibro- obliterative lesions

Exclusion criteria

Hepatic artery thrombosis or stenosis

Chronic ductopenic rejection

Anastomotic and non-anastomotic strictures before day 90 after LT

ABO incompatible LT

LT: Liver transplantation; PSC: Primary sclerosing cholangitis.

Table 2 Diagnostic criteria for recurrent primary biliary cirrhosis after liver transplantation[49]

Confirmed diagnosis of PBC in the explant histology

Characteristic histologic features1

Lymphoplasmacytic portal infiltrate

Lymphoid aggregates

Epithelioid granulomas

Evidence of bile duct injury

Persistence of AMA or AMA-M2

Exclusion of other causes of graft dysfunction

Acute and chronic rejection

Graft vs host disease

Bile flow impairment or cholangitis

Vascular complications

Viral hepatitis

Drug induced hepatitis

¹Definite recurrent PBC: 3 of 4 portal tract lesions are observed; Probable recurrent PBC: 2 of 4 portal tract lesions are observed. PBC: Primary biliary cirrhosis; AMA: Anti-mitochondrial antibodies.

Table 3 Diagnostic criteria of recurrent autoimmune hepatitis[60,64,69]

Liver transplantation for confirmed diagnosis of autoimmune hepatitis

Elevated transaminases

Hyper-gammaglobulinemia (elevation of IgG)

Presence of autoantibodies (ANA, SMA and/or anti-LKM1)

Compatible histopathology (interface hepatitis with portal inflammation and/or lymphoplasmacytic inflammatory infiltrates)

Response to corticosteroid

Exclusion of differential diagnostic considerations (including late/atypcial, acute cellular rejection)

IgG: Immunoglobulin G; ANA: Antinuclear antibodies; SMA: Smooth muscle antibodies; LKM1: Liver/kidney microsomal antibodies type 1.