Transplantation for autoimmune hepatitis

Autoimmune hepatitis (AIH) is a good indication for liver transplantation, with 5- and 10-year survival rates approaching 75%. Determining the timing for transplantation remains difficult because progression to end-stage disease may be difficult to predict. After transplantation, the patients are at risk of recurrent AIH. This syndrome is not well-characterized and requires clearer definition. Introduction of corticosteroids is not always associated with arrest of disease. De novo AIH may also develop in the allograft. Although there is usually a good response to the reintroduction of corticosteroids or greater immunosuppression, some patients develop graft failure. Patients grafted for AIH tend to be at higher risk for both acute and chronic rejection. Withdrawal of immunosuppression is unlikely to be achieved.