Clinical analysis of 36 cases of de novo autoimmune hepatitis after liver transplantation in a single center

Abstract

Objective To explore the clinical manifestations, diagnosis and treatment and prognosis of De novo autoimmune hepatitis (DNAH) after liver transplantation. Method The clinical features, biochemical and immunological parameters, pathological changes and prognosis of 36 cases of DNAH after liver transplantation from June 2002 to August 2014 were retrospectively analyzed. Result The clinical manifestations of DNAH were multiplex and lack of specificity, especially the ALT and AST increased significantly. The positive rate of serum antinuclear antibodies in 36 cases of DNAH was 86.1% (31/36), that of anti-mitochondrial antibody was 2.8% (1/36), and other autoantibodies were not detected. The positive rate of IgG was 61.1% (22/36). Infiltration of periportal and lobular lymphocytes and/or plasma cells in liver tissues was found in 17 cases (58.6%), interface hepatitis in 8 cases (27.6%), and liver cell rosette-like changes in 1 case (3.4%). In 36 cases of DNAH, 29 patients obtained a complete response (69.2%), 6 patients obtained a partial response (16.7%), and 1 patient (2.8%) with hepatitis C relapse during treatment had failure treatment. Among 29 cases of complete response, 27 cases (75.0%) achieved sustained remission, and recurrence occurred in 2 cases (5.6%). Conclusion The positive rate of serum antinuclear antibodies, IgG and abnormal liver pathological changes in 36 cases of DNAH was high, but the early diagnostic rate was low. The treatment responses for most patients with DNAH alone or in combination with azathioprine hormone were satisfactory, as long as the early detection and timely treatment could be given. Key words: Liver transplantation; Autoimmune hepatitis; Autoantibodies; Immunosuppressant