De novo autoimmune hepatitis in liver transplant: State-of-the-art review

In the two past decades, a number of communications, case-control studies, and retrospective reports have appeared in the literature with concerns about the development of a complex set of clinical, laboratory and histological characteristics of a liver graft dysfunction that is compatible with auto...

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Published inWorld journal of gastroenterology : WJG Vol. 22; no. 10; pp. 2906 - 2914
Main Authors Vukotic, Ranka, Vitale, Giovanni, D’Errico-Grigioni, Antonia, Muratori, Luigi, Andreone, Pietro
Format Journal Article
LanguageEnglish
Published United States Baishideng Publishing Group Inc 14.03.2016
Subjects
Animals
autoimmune
Autoimmunity
Diagnosis, Differential
Hepatitis, Autoimmune - diagnosis
Hepatitis, Autoimmune - etiology
Hepatitis, Autoimmune - immunology
Hepatitis, Autoimmune - therapy
hepatitis;Liver
hepatitis;Plasma-cell
Humans
Immunosuppressive Agents - adverse effects
Liver Transplantation - adverse effects
novo
Predictive Value of Tests
recurrence;Ant
Review
Risk Factors
transplant;Hepatitis
Treatment Outcome
virus
Autoimmunity
Antiviral therapy
Hepatitis C virus recurrence
Plasma-cell hepatitis
Liver transplant
Differential diagnosis
De novo autoimmune hepatitis
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Summary:In the two past decades, a number of communications, case-control studies, and retrospective reports have appeared in the literature with concerns about the development of a complex set of clinical, laboratory and histological characteristics of a liver graft dysfunction that is compatible with autoimmune hepatitis. The de novo prefix was added to distinguish this entity from a pre-transplant primary autoimmune hepatitis, but the globally accepted criteria for the diagnosis of autoimmune hepatitis have been adopted in the diagnostic algorithm. Indeed, de novo autoimmune hepatitis is characterized by the typical liver necroinflammation that is rich in plasma cells, the presence of interface hepatitis and the consequent laboratory findings of elevations in liver enzymes, increases in serum gamma globulin and the appearance of nonorgan specific auto-antibodies. Still, the overall features of de novo autoimmune hepatitis appear not to be attributable to a univocal patho-physiological pathway because they can develop in the patients who have undergone liver transplantation due to different etiologies. Specifically, in subjects with hepatitis C virus recurrence, an interferon-containing antiviral treatment has been indicated as a potential inception of immune system derangement. Herein, we attempt to review the currently available knowledge about de novo liver autoimmunity and its clinical management.
Bibliography:Ranka Vukotic;Giovanni Vitale;Antonia D’Errico-Grigioni;Luigi Muratori;Pietro Andreone;Dipartimento di Scienze Mediche e Chirurgiche,Università di Bologna,Policlinico Sant’Orsola-Malpighi;Dipartimento di Medicina Specialistica,Diagnostica e Sperimentale,Università di Bologna,"F.Addarii" Institute of Oncology and Transplantation Pathology,Policlinico Sant’Orsola-Malpighi
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Author contributions: Vukotic R performed the search and review of the literature data and drafted the manuscript; Vitale G contributed to the search and review of the literature and revised the draft; D’Errico-Grigioni A provided histological specimens images, their interpretation and description; Muratori L contributed to the expert review of the literature data and critically analyzed the manuscript for its scientific content; Andreone P contributed to the review and interpretation of the literature, revised the draft for its intellectual and scientific content and is the guarantor of this review article; all authors approved the final version of the manuscript.
Correspondence to: Pietro Andreone, MD, Professor of Internal Medicine, Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Policlinico Sant’Orsola-Malpighi, Via Massarenti, 9, 40138 Bologna, Italy. pietro.andreone@unibo.it
ISSN:1007-9327
2219-2840
2219-2840
DOI:10.3748/wjg.v22.i10.2906