Autoimmune diseases in transplanted livers

Liver transplantation (LT) is a standard therapeutic approach for the treatment of end-stage acute and chronic liver disease of various etiologies including autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), and primary sclerosing cholangitis (PSC). Results of LT for these autoimmune liver diseases are good, with a patient survival of 80 to 85% at 5 yr after LT. Transplant recipients, however, experience various complications, such as acute and chronic rejection, recurrence of disease, and chronic hepatitis. Recurrence of disease on the graft may be influenced by the genetic background of the recipient as well as other factors such as the degree of immunosuppression. Interestingly, autoimmunity and autoimmune disease can occur de novo following LT even for non-autoimmune liver diseases. However, the mechanisms that lead to autoimmunity or recurrence of autoimmune liver diseases after LT have not yet been defined. This chapter focuses on recurrence and occurrence of autoimmune diseases in transplanted livers.