Clinical relevance of autoantibodies after pediatric liver transplantation

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Clinical Transplantation

Volume 21 Issue 3 Page 427 - May/June 2007

Clinical Transplantation 21 (3), 427–432. doi:10.1111/j.1399-0012.2007.00667.x

Clinical relevance of autoantibodies after pediatric liver transplantation

RichteraaDepartment of Pediatrics, University Medical Center Hamburg-Eppendorf, Pediatric Gastroenterology and Hepatology, Hamburg, Enke GrabhornaaDepartment of Pediatrics, University Medical Center Hamburg-Eppendorf, Pediatric Gastroenterology and Hepatology, Hamburg, Knut HelmkeaaDepartment of Pediatrics, University Medical Center Hamburg-Eppendorf, Pediatric Gastroenterology and Hepatology, Hamburg, P. MannsbbDepartment of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany, Rainer GanschowaaDepartment of Pediatrics, University Medical Center Hamburg-Eppendorf, Pediatric Gastroenterology and Hepatology, Hamburg and BurdelskiaaDepartment of Pediatrics, University Medical Center Hamburg-Eppendorf, Pediatric Gastroenterology and Hepatology, Hamburg

aDepartment of Pediatrics, University Medical Center Hamburg-Eppendorf, Pediatric Gastroenterology and Hepatology, Hamburg, and bDepartment of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany

Richter, MD, Department of Pediatrics, Pediatric Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, istrasse 52, 20246 Hamburg, Germany.Tel.: +49 40 42803 4629; fax: +49 40 42803 5311;e-mail: a.richter@...

Richter A, Grabhorn E, Helmke K, Manns MP, Ganschow R, Burdelski M. Clinical relevance of autoantibodies after pediatric liver transplantation.Clin Transplant 2007: 21: 427–432. © Blackwell Munksgaard, 2007

Abstract

Background: The presence of autoantibodies and development of autoimmune hepatitis after liver transplantation has recently been reported as one of the causes for chronic graft dysfunction. The pathogenesis and clinical significance of this disease still remains unclear.

Methods: We evaluate 96 patients for the prevalence of autoantibodies and autoimmune hepatitis after pediatric liver transplantation and review their clinical follow-up including virus serologies, ultrasound examination and liver biopsies.

Results: Positive autoantibodies were detected in 74% of the patients after pediatric OLT. Graft dysfunction was observed in 46% of these children, and in 35% of the transplant recipients seronegative for autoantibodies. None of the patients showed histological signs or fulfilled clinical criteria for de novo autoimmune hepatitis. One child with negative autoantibodies was diagnosed to have a histologically proven de novo AIH two yr following OLT.

Conclusions: There is a high prevalence of autoantibodies after pediatric OLT, but the incidence of de novo AIH is very rare. In transplant recipients showing elevated liver function tests de novo autoimmune hepatitis has to be excluded by liver biopsy even if the patient is seronegative for autoantibodies.