Immunosuppression regimens in patients with end stage liver disease (ESLD) from autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC) and primary biliary cholangitis (PBC) typically include steroids however they can cause significant side effects. The aim of this study is to determine if a steroid-free immunosuppression protocol results in higher recurrence rates of autoimmune liver disease after liver transplant. A retrospective chart review was performed on 21 patients (8 for AIH, 7 for PSC, 6 for PBC) who underwent steroid free liver transplants for AIH, PSC or PBC at Scripps Green since 2000. All recurrences were diagnosed based on biopsy. The recurrence rate for all indications was found to be 24% (5/21) after an average follow up of 67 months. Acute graft rejection occurred in 48% (10/21) of subjects and was mostly mild in nature. There was an association between rejection episodes and recurrence of PSC, but not other autoimmune liver diseases. Treatment for rejection involved a steroid pulse in 30% (3/10) and a prolonged steroid taper in 60% (6/10) of patients. Graft survival was 95% during follow up (20/21) with the only failure occurring in the patient with AIH recurrence. This resulted in the only death in the study. Thirteen percent (1/8) of patients had recurrence of AIH after transplantation. Patients with PSC had a recurrence rate of 29% (2/7) at an average of 78 months post-transplant, but without graft failure. PBC patients were followed for an average of 78 months and had a recurrence rate of 33% (2/6), also without graft failure. The similarity in recurrence rates between our study and those published for liver transplants involving steroid immunosuppression indicate steroid-free protocols are a viable option for patients with autoimmune causes of end stage liver disease.

CITATION INFORMATION: Hooper A, Frenette C. Steroid-Free Immunosuppression After Liver Transplant for Autoimmune Disease Does Not Result in Increased Disease Recurrence. Am J Transplant. 2017;17 (suppl 3).

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