A cause of late graft dysfunction after liver transplantation in children: de-novo autoimmune hepatitis

Late graft dysfunction (LGD) after liver transplantation (LTx) is commonly associated with rejection, vascular complications, biliary complications, viral and bacterial infectious disease, and recurrence of primitive disease or post transplantation lymphoproliferative disease (PTLD). De-novo autoimmune hepatitis (AH) has recently been described as a possible cause of late graft dysfunction after pediatric and adult LTx not suffering from AH before LTx, once any of the previously mentioned causes of LGD can not be established. [1] and [2] This peculiar form of LGD appears to be associated to clinical, biochemical and histological features of an autoimmune disorder and can be effectively treated with the therapy protocols currently adopted for AH.1 In this study, we retrospectively reviewed our pediatric LTx series to investigate the occurrence of late graft dysfunction and de-novo AH and to analyze the circumstances of diagnosis, the clinical course and the results of therapeutic management of these patients.