Table 1 Main clinical and laboratory features of patients who developed graft dysfunction.
| Before antiviral treatment | During development of graft dysfunction | SVR | Outcome | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Patient | Sex | Age (years) | Months after LT | HCV genotype | Knodell score | Autoantibodies | Ig* | AIH score | HCV RNA by PCR | Knodell score | Autoantibodies | Ig* | AIH score | Other findings | ||
| 1 | M | 65 | 6 | 1 | 4‐3‐4‐3 | Negative | 1.5 | 2 | Negative | 5‐3‐4‐3 | ANA 1/40 | 2 | 14 | No | NA | Death for variceal bleeding |
| ASMA 1/40 | ||||||||||||||||
| 2 | F | 61 | 62 | 1 | 4‐3‐3‐1 | ANA 1/40 | 0.9 | 5 | Negative | 4‐3‐4‐3 | ANA 1/40 | 1.7 | 12 | Macrovesicular steatosis 40% | NA | Death for graft failure |
| 3 | F | 62 | 7 | 4 | 3‐1‐3‐1 | Negative | 0.5 | 1 | Negative | 4‐1‐3‐1 | ANA 1/40 | 1 | 10 | Macrovesicular steatosis 40% | Yes | Remission with steroids |
| 4 | M | 59 | 25 | 1 | 3‐1‐3‐1 | Negative | 1.2 | 5 | Negative | 5‐1‐4‐1 | ANA 1/320 | 1.5 | 10 | Ductopenia† | No | Improvement with steroids despite HCV relapse |
| 5 | M | 58 | 35 | 1 | 3‐1‐3‐1 | Negative | 0.7 | −1 | Negative | 4‐1‐3‐3 | ANA 1/40 | 0.9 | 14 | Ductopenia† Autoimmune thyroiditis | Yes | Remission with triple immunosuppression |
| 6 | M | 60 | 12 | 1 | 1‐3‐1‐1 | ANA 1/40 | 0.8 | 3 | Positive | 3‐3‐3‐1 | Anti‐dsDNA 1/10.240 | 1.9 | 10 | Macrovesicular steatosis 60% | No | Improvement with steroids despite HCV relapse |
| 7 | M | 55 | 19 | 1 | 4‐3‐3‐1 | ANA 1/640 | 1.2 | 5 | Negative | 4‐3‐3‐3 | c‐ANCA 1/80 | 1.9 | 11 | Cholangitis, SLE | No | Improvement with steroids despite HCV relapse |
| ASMA 1/160 | Anti‐dsDNA 1/80 | |||||||||||||||
| 8 | F | 60 | 3 | 2 | 3‐1‐3‐1 | Negative | 1.1 | 1 | Negative | 4‐3‐4‐1 | ASMA 1/40 | 1.5 | 10 | Cholangitis | Yes | Reenlisted for LT |
| Hepatic artery stenosis‡ | ||||||||||||||||
| Bile duct stenosis‡ | ||||||||||||||||
| 9 | M | 66 | 1 | 1 | 3‐1‐3‐1 | Negative | 1.2 | 0 | Negative | 5‐1‐4‐3 | AMA 1/40 | 2.2 | 10 | AMA positive cholangitis§ | Yes | Graft failure |
AIH, autoimmune hepatitis; ANA, antinuclear antibodies; ASMA, anti‐smooth‐muscle antibodies; HCV, hepatitis C virus; Ig, immunoglobulin; LT, liver transplant; NA, not available (negative at time of death); PCR, polymerase chain reaction; SLE, systemic lupus erythematosus; SVR, sustained virological response.
Knodell score: periportal necrosis—intralobular degeneration and focal necrosis—portal inflammation—fibrosis.
*Immunoglobulin level (× upper normal range).
†Ductopenia did not fulfil the criteria for chronic rejection.
‡These complications occurred 2 months after the diagnosis of de novo AIH.
§Diagnosis of AIH/primary biliary cirrhosis overlap syndrome.