Acute lobular hepatitis as the first manifestation of recurrent autoimmune hepatitis after orthotopic liver transplantation

TLDR

Lobular hepatitis has been reported in autoimmune hepatitis recurrence after immunosuppressive weaning in non‑transplanted patients, but not previously described in transplanted patients, highlighting the rarity of this histological feature. The study aims to detail the morphological features of recurrent autoimmune hepatitis post‑transplant and underscore the critical role of immunosuppressive therapy in these patients. Diagnosis relied on combined biological, serological, and morphological data, with confirmation by full recovery after steroid re‑initiation. In a 43‑year‑old man, recurrence manifested 4 months after transplantation with a sudden rise in liver enzymes and lobular hepatitis on biopsy, and the disease progressed slowly thereafter, likely due to cyclosporine and azathioprine.

Abstract

Abstract: Recurrence of autoimmune hepatitis after orthotopic liver transplantation and after reduction in immunosuppressive treatment is reported in a 43‐year‐old man. Diagnosis was based on biological, serological and morphological data, as well as on a complete biological recovery following steroid resumption. Recurrence was observed only 4 months after transplantation, when an abrupt increase in liver function tests was observed in association with a mainly lobular hepatitis in liver biopsy. Such a histological appearance has been previously described in the case of recurrence after immunosuppressive treatment weaning in non‐transplanted patients. In contrast, this histological feature has not been reported in the rare transplanted patients in whom such recurrence has been observed. Thereafter, the evolution of the disease in our patient remained slow, likely dampened by the administration of cyclosporine and azathioprine. Morphological features are detailed, and importance of immunosuppressive therapy in patients transplanted for end‐stage autoimmune hepatitis is emphasized.