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  • Post-Transplant Immunosuppr...
    Kelly, Claire; Zen, Yoh; Heneghan, Michael A.

    Journal of clinical and experimental hepatology, 03/2023, Letnik: 13, Številka: 2
    Journal Article

    Autoimmune liver diseases (AILDs) are a group of conditions where immune-mediated liver damage can lead to the need for transplantation. Collectively, they account for almost a quarter of all liver transplants. Outcomes in terms of graft and patient survival for all liver transplants have improved markedly over decades with improvements in patient selection, surgical techniques and longer-term care and this is also seen in patients with AILDs. The current five- and ten-year survival rates post-transplant in autoimmune disease are excellent, at 88% and 78%, respectively. A key factor in maintaining good outcomes post liver transplant for these autoimmune conditions is the immunosuppression strategy. These patients have increased the rates of rejection, and autoimmune conditions can all recur in the graft ranging from 12 to 60% depending on the population studied. Immunosuppressive regimens are centred on calcineurin inhibitors, often combined with low dose corticosteroids, with or without the addition of antimetabolite therapy. There is no clear evidence-based immunosuppressive regimen for these conditions, and a tailored approach balancing the individuals’ immunological profile against the risks of immunosuppression is often used. There are disease-specific considerations to optimised graft function including the role of ursodeoxycholic acid in both primary biliary cholangitis and primary sclerosing cholangitis and the role and timing of colectomy in primary sclerosing cholangitis in inflammatory bowel disease patients. However, unmet needs still exist in the management of AILDs post liver transplantation particularly in building the evidence base for optimal immunosuppression as well as mitigating the risk of recurrent disease. Display omitted •Collectively, autoimmune liver diseases (AILDs) represent a significant requirement for organs in liver transplant programs. Long-term outcomes for these patients have improved, with excellent one- and five-year survival (90% and 70%, respectively).•As well as the transplant indications seen in other forms of chronic liver disease, there are unique indications for transplantation seen in AILDs such as recurrent cholangitis in primary sclerosing cholangitis.•Furthermore, there are also special considerations post liver transplantation in these conditions. All forms of AILD can recur post transplantation, and there is an increased risk of rejection. In this article, we discuss the need to balance the selection of immunosuppression for long-term optimal graft and patient survival with the complications of these drugs.•Additionally, we highlight prognostic- and disease- specific treatment options for each of the main AILDs after liver transplantation in terms of immunosuppression strategy and any disease modifying therapies.