Autoimmunity in the setting of liver transplantation

Autoimmune liver diseases are frequent indication for orthotopic liver transplantation (LT). Furthermore, autoimmune markers' are frequently found in other liver diseases such as viral hepatitis. This study aimed to determine the prevalence of autoimmune markers in LT candidates and their impact on the outcome of LT. Methods: 700 LT were performed at UCSF between February 1988 and April 1995. 358 HBsAg negative, first transplant recipients for whom complete pre-transplant viral and immunological data were available were included in the study. The mean age was 47±14 years (range: 0-71). The mean duration of follow-up was 36.9±18.6 months. Patients with anti-HCV by ELISA or RIBA prior to LT were considered HCV-infected. Survival analyses were performed using Cox regression. Results: Prior to LT, antinuclear antibodies (ANA), anti-smooth muscle antibodies (SMA) and anti-mitochondrial antibodies and were detected in 36%, 45.2% and 4.7% of the patients respectively. There was a rank correlation between ANA titer and age (r=0.24, p=.0001). Pre-transplantation HCV infection was found in 32.1% of the patients. 30.4% of the HCV (+) patients and 38.7% of the HCV (-) patients were ANA positive (p=.16). There was no association between diagnosis and presence of both ANA and SMA. The relative risk for death after LT increased significantly with age (p<.0004). For ANA (+) patients, the relative risk for death, controlled for age, was 0.615 (CI: 0.34-1.1, p=.10). For HCV (+) patients, the relative risk for death, controlled for age, was 0.78 (CI: 0.43-1.41, p=.4). When compared to ANA (-) HCV (-) patients, the relative risk for death for ANA (+) HCV (-) patients was 0.57 (CI: 0.29-1.1, p=. 10) and the relative risk for death for ANA (+) HCV (+) patients was 0.51 (CI: 0.18-1.16, p=.21). Summary: Markers of autoimmunlty are common in liver transplant candidates, regardless of the liver disease. While increasing age has a negative affect on post-LT survival, our results fail to show that the presence of ANA prior to LT is independently associated with worse survival after LT.