Autoimmune hepatitis surgery: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Autoimmune hepatitis}} | {{Autoimmune hepatitis}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{MKK}} | ||
==Overview== | ==Overview== | ||
Liver transplantation is indicated when medical therapy fails, decompensated chronic [[Liver diseases|liver disease]], fulminant [[hepatic failure]], [[hepatocellular carcinoma]] and [[MELD score]] of >15 or a [[Child-Pugh score]] of >10277. If AIH recurs after liver transplanation, Reintroduction of [[corticosteroids]] and [[azathioprine]] is usually given. | |||
==Surgery== | ==Surgery== | ||
===Liver Transplantation === | ===Liver Transplantation === | ||
Liver transplantation is indicated in the following condition:<ref name="pmid11003612">{{cite journal |vauthors=Reich DJ, Fiel I, Guarrera JV, Emre S, Guy SR, Schwartz ME, Miller CM, Sheiner PA |title=Liver transplantation for autoimmune hepatitis |journal=Hepatology |volume=32 |issue=4 Pt 1 |pages=693–700 |year=2000 |pmid=11003612 |doi=10.1053/jhep.2000.16666 |url=}}</ref><ref name="pmid9123100">{{cite journal |vauthors=Ahmed M, Mutimer D, Hathaway M, Hubscher S, McMaster P, Elias E |title=Liver transplantation for autoimmune hepatitis: a 12-year experience |journal=Transplant. Proc. |volume=29 |issue=1-2 |pages=496 |year=1997 |pmid=9123100 |doi= |url=}}</ref><ref name="pmid17524922">{{cite journal |vauthors=Khalaf H, Mourad W, El-Sheikh Y, Abdo A, Helmy A, Medhat Y, Al-Sofayan M, Al-Sagheir M, Al-Sebayel M |title=Liver transplantation for autoimmune hepatitis: a single-center experience |journal=Transplant. Proc. |volume=39 |issue=4 |pages=1166–70 |year=2007 |pmid=17524922 |doi=10.1016/j.transproceed.2007.02.030 |url=}}</ref> | [[Liver transplantation]] is indicated in the following condition:<ref name="pmid11003612">{{cite journal |vauthors=Reich DJ, Fiel I, Guarrera JV, Emre S, Guy SR, Schwartz ME, Miller CM, Sheiner PA |title=Liver transplantation for autoimmune hepatitis |journal=Hepatology |volume=32 |issue=4 Pt 1 |pages=693–700 |year=2000 |pmid=11003612 |doi=10.1053/jhep.2000.16666 |url=}}</ref><ref name="pmid9123100">{{cite journal |vauthors=Ahmed M, Mutimer D, Hathaway M, Hubscher S, McMaster P, Elias E |title=Liver transplantation for autoimmune hepatitis: a 12-year experience |journal=Transplant. Proc. |volume=29 |issue=1-2 |pages=496 |year=1997 |pmid=9123100 |doi= |url=}}</ref><ref name="pmid17524922">{{cite journal |vauthors=Khalaf H, Mourad W, El-Sheikh Y, Abdo A, Helmy A, Medhat Y, Al-Sofayan M, Al-Sagheir M, Al-Sebayel M |title=Liver transplantation for autoimmune hepatitis: a single-center experience |journal=Transplant. Proc. |volume=39 |issue=4 |pages=1166–70 |year=2007 |pmid=17524922 |doi=10.1016/j.transproceed.2007.02.030 |url=}}</ref> | ||
*Medical therapy fails | *Medical therapy fails | ||
*Decompensated chronic liver disease | *Decompensated chronic [[Liver diseases|liver disease]] | ||
*Fulminant hepatic failure | *Fulminant [[hepatic failure]] | ||
*Hepatocellular carcinoma | *[[Hepatocellular carcinoma]] | ||
*MELD score of >15 or a Child-Pugh score of >10277 | *[[MELD score]] of >15 or a [[Child-Pugh score]] of >10277 | ||
'''''For more information about liver transplantation click [[Liver transplantation|here]].''''' | |||
=='De novo’ AIH following liver transplantation== | =='De novo’ AIH following liver transplantation== | ||
AIH can recur in the transplanted liver | AIH can recur in the transplanted liver. Two patterns of disease are described:<ref name="pmid9927160">{{cite journal |vauthors=Ratziu V, Samuel D, Sebagh M, Farges O, Saliba F, Ichai P, Farahmand H, Gigou M, Féray C, Reynès M, Bismuth H |title=Long-term follow-up after liver transplantation for autoimmune hepatitis: evidence of recurrence of primary disease |journal=J. Hepatol. |volume=30 |issue=1 |pages=131–41 |year=1999 |pmid=9927160 |doi= |url=}}</ref><ref name="pmid10440397">{{cite journal |vauthors=Milkiewicz P, Hubscher SG, Skiba G, Hathaway M, Elias E |title=Recurrence of autoimmune hepatitis after liver transplantation |journal=Transplantation |volume=68 |issue=2 |pages=253–6 |year=1999 |pmid=10440397 |doi= |url=}}</ref><ref name="pmid9884253">{{cite journal |vauthors=Prados E, Cuervas-Mons V, de la Mata M, Fraga E, Rimola A, Prieto M, Clemente G, Vicente E, Casanovas T, Fabrega E |title=Outcome of autoimmune hepatitis after liver transplantation |journal=Transplantation |volume=66 |issue=12 |pages=1645–50 |year=1998 |pmid=9884253 |doi= |url=}}</ref><ref name="pmid9482295">{{cite journal |vauthors=Kerkar N, Hadzić N, Davies ET, Portmann B, Donaldson PT, Rela M, Heaton ND, Vergani D, Mieli-Vergani G |title=De-novo autoimmune hepatitis after liver transplantation |journal=Lancet |volume=351 |issue=9100 |pages=409–13 |year=1998 |pmid=9482295 |doi=10.1016/S0140-6736(97)06478-7 |url=}}</ref> | ||
Two patterns of disease are described: | *First, who has detectable anti-LKM1 [[antibodies]] at high titer in combination with a serum [[AST]] level >500 IU/l, | ||
*First, | *Second associated with the presence of [[ANA]] or [[ASMA|ASMA]] at lower titers (>1:80) and lower [[AST]] levels. | ||
*Second associated with the presence of ANA or ASMA at lower titers (>1:80) and lower AST levels | |||
Treatment: | ===Treatment:=== | ||
*Reintroduction of corticosteroids and azathioprine | *Reintroduction of [[corticosteroids]] and [[azathioprine]]. | ||
==References== | ==References== | ||
Latest revision as of 19:09, 9 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
Liver transplantation is indicated when medical therapy fails, decompensated chronic liver disease, fulminant hepatic failure, hepatocellular carcinoma and MELD score of >15 or a Child-Pugh score of >10277. If AIH recurs after liver transplanation, Reintroduction of corticosteroids and azathioprine is usually given.
Surgery
Liver Transplantation
Liver transplantation is indicated in the following condition:[1][2][3]
- Medical therapy fails
- Decompensated chronic liver disease
- Fulminant hepatic failure
- Hepatocellular carcinoma
- MELD score of >15 or a Child-Pugh score of >10277
For more information about liver transplantation click here.
'De novo’ AIH following liver transplantation
AIH can recur in the transplanted liver. Two patterns of disease are described:[4][5][6][7]
- First, who has detectable anti-LKM1 antibodies at high titer in combination with a serum AST level >500 IU/l,
- Second associated with the presence of ANA or ASMA at lower titers (>1:80) and lower AST levels.
Treatment:
- Reintroduction of corticosteroids and azathioprine.
References
- ↑ Reich DJ, Fiel I, Guarrera JV, Emre S, Guy SR, Schwartz ME, Miller CM, Sheiner PA (2000). "Liver transplantation for autoimmune hepatitis". Hepatology. 32 (4 Pt 1): 693–700. doi:10.1053/jhep.2000.16666. PMID 11003612.
- ↑ Ahmed M, Mutimer D, Hathaway M, Hubscher S, McMaster P, Elias E (1997). "Liver transplantation for autoimmune hepatitis: a 12-year experience". Transplant. Proc. 29 (1–2): 496. PMID 9123100.
- ↑ Khalaf H, Mourad W, El-Sheikh Y, Abdo A, Helmy A, Medhat Y, Al-Sofayan M, Al-Sagheir M, Al-Sebayel M (2007). "Liver transplantation for autoimmune hepatitis: a single-center experience". Transplant. Proc. 39 (4): 1166–70. doi:10.1016/j.transproceed.2007.02.030. PMID 17524922.
- ↑ Ratziu V, Samuel D, Sebagh M, Farges O, Saliba F, Ichai P, Farahmand H, Gigou M, Féray C, Reynès M, Bismuth H (1999). "Long-term follow-up after liver transplantation for autoimmune hepatitis: evidence of recurrence of primary disease". J. Hepatol. 30 (1): 131–41. PMID 9927160.
- ↑ Milkiewicz P, Hubscher SG, Skiba G, Hathaway M, Elias E (1999). "Recurrence of autoimmune hepatitis after liver transplantation". Transplantation. 68 (2): 253–6. PMID 10440397.
- ↑ Prados E, Cuervas-Mons V, de la Mata M, Fraga E, Rimola A, Prieto M, Clemente G, Vicente E, Casanovas T, Fabrega E (1998). "Outcome of autoimmune hepatitis after liver transplantation". Transplantation. 66 (12): 1645–50. PMID 9884253.
- ↑ Kerkar N, Hadzić N, Davies ET, Portmann B, Donaldson PT, Rela M, Heaton ND, Vergani D, Mieli-Vergani G (1998). "De-novo autoimmune hepatitis after liver transplantation". Lancet. 351 (9100): 409–13. doi:10.1016/S0140-6736(97)06478-7. PMID 9482295.