The aim of this study was to analyze longterm patient and graft survival after liver transplantation for autoimmune hepatitis (AIH-LT) from the prospective multicenter European Liver Transplant Registry. Patient and liver graft survival between 1998 and 2017 were analyzed. Patients after AIH-LT (n = 2515) were compared with patients receiving LT for primary biliary cholangitis (PBC-LT; n = 3733), primary sclerosing cholangitis (PSC-LT; n = 5155), and alcohol-related cirrhosis (AC-LT; n = 19,567). After AIH-LT, patient survival was 79.4%, 70.8%, and 60.3% and graft survival was 73.2%, 63.4%, and 50.9% after 5, 10, and 15 years of follow-up. Overall patient survival was similar to patients after AC-LT (P = 0.44), but worse than after PBC-LT (hazard ratio [HR], 1.48; P < 0.001) and PSC-LT (HR, 1.19; P = 0.002). AIH-LT patients were at increased risk for death (HR, 1.37-1.84; P < 0.001) and graft loss (HR, 1.35-1.80; P < 0.001) from infections compared with all other groups and had a particularly increased risk for lethal fungal infections (HR, 3.38-4.20; P ≤ 0.004). Excluding patients who died within 90 days after LT, risk of death after AIH-LT was superior compared with AC-LT (HR, 0.84; P = 0.004), worse compared with PBC-LT (HR, 1.38; P < 0.001) and similar compared with PSC-LT (P = 0.93). Autoimmune hepatitis (AIH) patients with living donor liver transplantation (LDLT) showed reduced survival compared with patients receiving donation after brain death (HR, 1.96; P < 0.001). In AIH-LT patients, overall survival is inferior to PBC-LT and PSC-LT. The high risk of death after AIH-LT is caused mainly by early fatal infections, including fungal infections. Patients with LDLT for AIH show reduced survival.

1 Department of Medicine University Medical Center Hamburg Eppendorf Hamburg Germany

Avicenna Center for Medicine and Organ Transplant Shiraz University of Medical Sciences Shiraz Iran

Department of General Transplant and Liver Surgery Medical University of Warsaw Warsaw Poland

Department of Hepatobiliary and Digestive Surgery Pontchaillou University Hospital Rennes France

Department of Hepatology and Gastroenterology University Hospital of Henri Mondor Creteil France

Department of HPB Surgery Queen Elizabeth Hospital Birmingham United Kingdom

Department of Internal Medicine 4 University Hospital Heidelberg Heidelberg Germany

Department of Surgery Charité Universitätsmedizin Berlin Campus Charité Mitte and Campus Virchow Klinikum Berlin Germany

Department of Transplant Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic

Department of Visceral and Transplant Surgery University Hospital Essen Essen Germany

European Reference Network for Hepatological Diseases Hamburg Germany

Hepato Biliary Center AP HP Paul Brousse Hospital University of Paris Sud Villejuif France

King's Liver Transplant Unit King's College Hospital NHS Foundation Trust London United Kingdom

Liver Transplantation and Hepatology Unit La Fe University Hospital Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas University of Valencia Valencia Spain

Martin Zeitz Center for Rare Diseases University Medical Centre Hamburg Eppendorf Hamburg Germany

The Leeds Teaching Hospitals NHS Trust Leeds United Kingdom

Liver Transpl. 2020 Jul;26(7):861-862. doi: 10.1002/lt.25782. PubMed

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