Autoimmune hepatitis surgery
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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
'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 A SMA 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.