A clinico-pathological analysis of de novo positive anti-nuclear antibody following liver transplantation

Abstract

Objective To study the clinicopathological features of de novo anti-nuclear antibody (ANA) positive patients following liver transplantation.Method A retrospective analysis on the clinicopathological data of 32 ANA-positive patients after liver transplantation.The correlation of autoimmune hepatitis (AIH) scores,autoantibodies,alanine aminotransferase (ALT),alkaline phosphatase(ALP)/ALT ratio,IgG/normal ratio and pathological manifestations was analyzed.Result In 32 patients,the percentage of patients with AIH scores above 15 points (definite AIH),10 to 15 (possible AIH) and below 10 points (non-AIH) was 12.5％ (4/32),40.6％ (13/32) and 46.9％ (15/32),respectively.The percentage of patients with ALP/ALT ratio below 1.5 and IgG/normal ratio above 1.5 was 100.0％ (4/4),15.4％ (2/13) and 0％ (0/15) respectively in three groups.The was significant difference among three groups (P =0.000).The percentage of patients with moderate lymphocytic periportal inflammation,interface inflammation and inflammation around the central vein together was 100.0％ (4/4),49.2％ (6/13) and 13.3％ (2/15) respectively.There was significant difference in pathological characteristics (P =0.003).No significant correlation was found between AIH score and single antibody titers,the magnitude of elevated ALT,pathological characteristics (P＞0.05).The incidence rate of patients with ALT below 40 U/L,41 to 100 U/L and above 100 U/L was 0(0/2),60.0％ (9/15),and 100.0％ (15/15),respectively.There was significant difference (P =0.001).Conclusion In these cases,most patients can not be diagnosed with AIH according to AIH scoring criteria.It should be analyzed and judged with clinical,specifically pathological characteristics and AIH score when ANA expression was positive,to exclude rejection,viral hepatitis and drug-induced factors.ALP/ALT ratio below 1.5 and IgG/normal ratio above 1.5 can be considered as clinical indication of de novo autoimmune hepatitis. Key words: Liver transplantation; Antibodies, antinuclear; Pathology; Clinical; Complications; Hepatitis, autoimmune