8. Liver transplantation for autoimmune liver disease: a single centre experience

Abstract

Background and Aims: Autoimmune liver diseases (AILD) include Autoimmune hepatitis (AIH), Primary biliary cirrhosis (PBC), Primary sclerosing cholangitis (PSC), and Overlap syndromes. Patients with these conditions eventually progress to End stage liver disease requiring transplantation. Long term outcome of Liver transplantation (LT) in India for this condition is unknown. We aim to evaluate the outcome of patients who underwent Liver transplantation for AILD. Methods: A retrospective analysis of 60 adult patients with AILD who underwent LT in Gleneagles Global Health City, Chennai, from August 2009 to April 2018 was carried out. Patient demographics, dosage of immunosuppressant level, number of rejection episodes and graft and patient survival were calculated. Results: A total of 60 patients underwent LT for AILD. Out of 60 patients, 30 had AIH, 14 had PSC, 4 had PBC and 5 had Overlap syndrome. 53% of population was males. Median age was 39 years (18 to 52 years). The Model for End-stage Liver Disease (MELD) score was 18 (7 to 36). All patients were commenced on triple immunosuppression (tacrolimus, mycophenolate and corticosteroids) and maintained on long term corticosteroids. Biopsy proven acute cellular rejection (BPAR) occurred in 15 (25%) recipients and two thirds of ACR occurred within the first 10 post-operative days. These patients were treated with intravenous methylprednisolone therapy and improved with no graft loss. Thirteen patients developed sepsis but had no graft loss. One patient developed recurrent PSC and is managed medically. Overall patient survival was 95%. Three patients (5%) died during the follow up period. The cause of death were recurrent AIH, ischaemic heart disease and sepsis, respectively. Conclusions: Patients transplanted for AILD may have higher incidence of acute cellular rejection. However, this did not affect the overall outcome. Liver transplantation is the effective treatment for end stage AILD with excellent long term graft and patient survival. The authors have none to declare.