DE NOVO AUTOIMMUNE HEPATITIS AFTER LIVER TRANSPLANTATION IN CHILDREN. REVIEW

Abstract

De novo autoimmune hepatitis (AIH) is a clinical disease similar to AIH that develops in liver transplant recipients with diseases other than AIH. Timely recognition of this disease makes it possible to avoid graft rejection and liver re-transplantation (LT), liver fibrosis, and can ensure a long life expectancy, given the effectiveness of more active immunosuppression with the use of corticosteroids and azathioprine, as in the treatment of idiopathic AIH. The de novo prefix was added to distinguish this condition from primary autoimmune hepatitis prior to transplant, but the diagnostic algorithm adopted generally accepted diagnostic criteria for autoimmune hepatitis. In fact, de novo autoimmune hepatitis is characterized by typical necroinflammation of the liver, rich in plasma cells, increased serum gammaglobulin levels, and the appearance of inorganic specific autoantibodies. However, the general signs of autoimmune hepatitis de novo, apparently, cannot be associated with an unambiguous pathophysiological pathway, since they can develop in patients undergoing liver transplantation due to different etiologies. The literature review presents such aspects as the prevalence of this case, the influence of the HLA phenotype on the manifestation and outcome of the disease, diagnosis and treatment. Objective. To conduct a literary meta-analysis of scientific publications on the development of De novo Autoimmune hepatitis after liver transplantation in children. Materials and methods. The authors selected scientific bases for the search such as: Web of science, Cyberleninka, UpToDate, Pubmed and Cochrane, Google Scholar. Results. A meta-analysis of scientific articles in English and Russian was carried out for the selected keywords. The causes of development were not infectious or surgical complications. Liver biopsy revealed histological changes typical of acute or chronic ovulation. High levels of transaminases, hypergammaglobulinemia, positivity to autoantibodies – ANA, AMA, SMA, anti-LKM-1. De novo AIH patients did not respond to conventional anti-rejection therapy, but responded only to classical AIH therapy.