Unexplained late centrilobular hepatitis after liver transplantation - Relationship to autoimmune hepatitis and GST-T1 mismatch

Clouston, A., Campbell, C., Lynch, S., Jonsson, J., Balderson, G., Barrie, H. and Crawford, D. (2005). Unexplained late centrilobular hepatitis after liver transplantation - Relationship to autoimmune hepatitis and GST-T1 mismatch. In: 56th Annual Meeting of the American Association for the Study of Liver Diseases, San Francisco, CA, United States, (334A-335A). 11-15 November 2005. doi:10.1002/hep.20924


Author Clouston, A.
Campbell, C.
Lynch, S.
Jonsson, J.
Balderson, G.
Barrie, H.
Crawford, D.
Title of paper Unexplained late centrilobular hepatitis after liver transplantation - Relationship to autoimmune hepatitis and GST-T1 mismatch
Conference name 56th Annual Meeting of the American Association for the Study of Liver Diseases
Conference location San Francisco, CA, United States
Conference dates 11-15 November 2005
Journal name Hepatology   Check publisher's open access policy
Place of Publication Hoboken, NJ, United States
Publisher John Wiley & Sons
Publication Year 2005
Sub-type Published abstract
DOI 10.1002/hep.20924
ISSN 0270-9139
1527-3350
Volume 42
Issue S1
Start page 334A
End page 335A
Total pages 1
Language eng
Formatted Abstract/Summary
Background: Following transplantation (OLT), centrilobular hepatitis
(CLH) develops in 10% of patients. A minority represent
acute rejection (AR), chronic rejection (CR), autoimmune hepatitis
(AIH) or vascular compromise, diagnosable by portal changes or
imaging. The remainder are of uncertain nature and have been
attributed to a form of AR or AIH. Recently, post-OLT de novo
AIH has been linked to GST-T1 mismatch between the donor and
recipient; 20% of patients harbour a gene polymorphism that
prevents protein expression.
Aims: To characterise cases of CLH histologically and clinically, to
document the natural history and to investigate a possible mechanism.
Methods: Since 1999, 24 patients with prominent CLH without
portal changes of AR or CR have been identified prospectively.
One noncompliant patient progressed rapidly to CR and was not
further assessed. Based on primary disease, autoantibody titers
and histology, cases were classified as recurrent AIH (AIH-R,
n=5), de novo AIH (AIH-DN, n=5) or CLH (n=13). Biopsies were
graded for portal, interface, lobular and confluent centrilobular
inflammatory activity (Ishak), for individual features of rejection
(Banff) and for inflammatory cell infiltrates including plasma cells
(PC) and eosinophils. LFTs and autoantibodies (n=22) were assessed,
and evolution was determined by LFT changes and subsequent
biopsies (n=7). GST-T1 status of recipients was assessed
by PCR.
Results: The mean onset was 1066 days post-OLT (range 30-2850)
with earlier onset for CLH (541=221, p=0.01). In CLH, portal
changes including interface hepatitis, inflammation and PC were
milder (p=0.002 for all). Centrilobular inflammation and lobular
PC were similar between groups, but centrilobular dropout was
milder (p=0.02). LFT changes were not significantly different between
groups. Autoantibodies were found in 7/13 CLH patients. 5
patients with CLH responded to an AIH treatment protocol. Of
untreated patients, 4 have hepatitis C (with LFT changes), 2 resolved
and 2 have ongoing LFT fluctuation. No patient has developed
AR or CR. In recipients, the non-expressing GST-T1
polymorphism was found at similar frequencies in AIH-R (3/5),
AIH-DN (2/4) and CLH (4/12)(p=0.7, NS), a significantly higher
frequency than control OLT patients (0/15, p=0.004).
Conclusions: CLH is a common late finding after OLT (13%). The
clinical and histological features overlap with autoimmune type
hepatitis but it is milder, and responds to the re-introduction of
steroids. Untreated, it may resolve or persist but does not progress
to CR. It shares a potential pathogenic mechanism with de-novo
AIH. We propose renaming it autoimmune-like CLH.
Q-Index Code EX
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Conference Paper
Collection: School of Medicine Publications
 
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Created: Wed, 09 Mar 2011, 08:36:26 EST