Long-term outcome of liver transplantation for autoimmune hepatitis: a French nationwide study over 30 years.

BACKGROUND & AIMS: Autoimmune hepatitis (AIH) is a rare indication for liver transplantation (LT). The aims of this study were to evaluate long-term survival after LT for AIH and prognostic factors, especially the impact of recurrent AIH (rAIH).

METHODS: A multicenter retrospective nationwide study including all patients aged ≥16 transplanted for AIH in France was conducted. Early deaths and retransplantations (≤ 6 months) were excluded.

RESULTS: The study population consisted in 301 patients transplanted from 1987 to 2018. Median age at LT was 43 years (IQR, 29.4-53.8). Median follow-up was 87.0 months (IQR, 43.5-168.0). Seventy-four patients (24.6%) developed rAIH. Graft survival was 91%, 79%, 65% at 1, 10, and 20 years, respectively. Patient survival was 94%, 84% and 74% at 1, 10 and 20 years, respectively. From multivariate Cox regression, factors significantly associated with poorer patient survival were patient age ≥ 58 years (HR=2.9; 95% CI, 1.4-6.2; p=0.005) and occurrence of an infectious episode within the 1st year after LT (HR=2.5; 95% CI, 1.2-5.1; p=0.018). Risk factors for impaired graft survival were: occurrence of rAIH (HR=2.7; 95% CI, 1.5-5.0; p=0.001), chronic rejection (HR=2.9; 95% CI, 1.4-6.1; p=0.005), biliary (HR=2.0; 95% CI, 1.2-3.4; p=0.009), vascular (HR=1.8; 95% CI, 1.0-3.1; p=0.044) and early septic (HR=2.1; 95% CI, 1.2-3.5; p=0.006) complications.

CONCLUSION: Our results confirm that survival after LT for AIH is excellent. Disease recurrence and chronic rejection reduce graft survival. The occurrence of an infectious complication during the first year post-LT identifies at-risk patients for graft loss and death.