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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Risk factors for autoimmune liver disease recurrence after liver transplantation
Moisés Salgado-de la Mora, Osvely Mendez-Guerrero, Aldo Torre, Mario Vilatoba, Graciela E Castro Narro, Mario Isaac Lumbreras Márquez, Nalu Navarro-Alvarez
Moisés Salgado-de la Mora, Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, 14080, Mexico
Osvely Mendez-Guerrero, Graciela E Castro Narro, Nalu Navarro-Alvarez, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, 14080, Mexico
Aldo Torre, Department of Gastroenterology, Centro Médico ABC, Mexico City, 01120, Mexico
Mario Vilatoba, Department of Transplant, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, 14080, Mexico
Mario Isaac Lumbreras Márquez, Division of Epidemiology and Public Health, Universidad Panamericana School of Medicine, Mexico City, 03920, Mexico
Nalu Navarro-Alvarez, Department of Surgery, University of Colorado Anschutz Medical Campus, Denver, CO 80045, United States
Author contributions: Salgado-de la Mora M was responsible for study concept and design, acquisition of data, analysis and interpretation of data, writing of the original manuscript; Mendez-Guerrero O was responsible for statistical analysis, review and editing; Torre A was responsible for review and editing; Vilatoba M was responsible for review and editing; Castro Narro GE was responsible for review and editing; Lumbreras Márquez MI was responsible for analysis and interpretation of data, statistical analysis, writing of the original manuscript, review and editing; Navarro-Alvarez N was responsible for critical revision of the manuscript for important intellectual content, study supervision, writing of the original manuscript, review and editing; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: This study was approved by our institutional review board with the approval GAS 4670-23-24-1.
Informed consent statement: Given the retrospective nature of the study and the use of de-identified data, the requirement for informed consent was waived in accordance with institutional guidelines and ethical regulations.
Conflict-of-interest statement: The authors declare no conflict of interest exist.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: All relevant data are included in the manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Nalu Navarro-Alvarez, MD, PhD, Assistant Professor, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 15 Vasco de Quiroga, Mexico City, 14080, Mexico.
nalu.navarroa@incmnsz.mx
Received: March 11, 2025
Revised: May 21, 2025
Accepted: July 25, 2025
Published online: December 18, 2025
Processing time: 253 Days and 12.2 Hours
BACKGROUND
Autoimmune liver disease (AILD) recurrence is common after liver transplantation (LT). While several risk factors for recurrence have been identified, their combined predictive value has yet to be thoroughly investigated.
AIM
To evaluate the combined predictive value of clinical and laboratory risk factors for AILD recurrence after LT.
METHODS
This retrospective cohort study included 79 patients with AILD who underwent LT at a single liver transplant center. We compared clinical and laboratory variables between patients with and without recurrent disease and assessed the predictive performance of these factors using four logistic regression models and their corresponding area under the receiver operating characteristic curve (AUC).
RESULTS
Recurrent AILD occurred in 26.58% of patients (95%CI: 17-38), the median time to recurrence was 28 months (interquartile range: 16-38). Patients with recurrent AILD had significantly higher pre-transplant Child-Pugh scores [11.61 ± 1.16 vs 10.58 ± 1.96 points; odds ratio (OR) = 1.43, 95%CI: 1.03-2.00; P = 0.032] and model for end-stage liver disease score (MELD) (22.76 ± 5.47 vs 18.81 ± 7.24 points; OR = 1.08, 95%CI: 1.01-1.16; P = 0.032), compared to those without recurrence. Additionally, baseline alanine aminotransferase (ALT) > 2 times the upper limit of normal (ULN) was significantly associated with recurrence (31% vs 57.1%; OR = 2.96, 95%CI: 1.06-8.28; P = 0.038). Our models, incorporating several risk variables, demonstrated moderate predictive ability for AILD recurrence. The AUCs were as follows: (1) Model 1 (AUC = 0.75, 95%CI: 0.58-0.87); (2) Model 2 (AUC = 0.74, 95%CI: 0.59-0.90); (3) Model 3 (AUC = 0.72, 95%CI: 0.58-0.88); and (4) Model 4 (AUC = 0.63, 95%CI: 0.40-0.76), with no statistically significant difference between the models (P = 0.488).
CONCLUSION
Higher pre-transplant Child-Pugh and MELD scores, as well as ALT > 2 ULN, were associated with an increased risk of AILD recurrence.
Core Tip: Autoimmune liver disease (AILD) recurrence after liver transplantation remains a significant concern, yet its predictive factors are not well established. This retrospective cohort study identified higher pre-transplant Child-Pugh and model for end-stage liver disease score, along with alanine aminotransferase > 2 times the upper limit of normal, as significant risk factors for recurrence. Using logistic regression models, we demonstrated a moderate predictive ability for recurrence, though no single model outperformed the others. These findings provide insights into risk stratification, potentially aiding in post-transplant management and surveillance strategies for AILD patients.
