Scientists talked about the causes of cirrhosis after liver transplantation

Cirrhosis can also develop in a transplanted liver, and most often this is due to the return of the disease that caused the patient to need a transplant. In a study involving 937 people, repeated cirrhosis was detected in 107 patients. The article "Izvestia" explains why organ replacement does not always eliminate the risk of disease and what conclusions scientists have drawn.

Why does cirrhosis occur again

During transplantation, the damaged liver is replaced with a donor organ. However, the disease that led to cirrhosis may in some cases affect the transplanted liver. In addition, other causes of chronic organ damage may appear after surgery. In both cases, the changes develop gradually, so it is important to assess the condition of the liver years after the transplant.

To find out how often repeated cirrhosis occurs and what it is associated with, researchers from the Medical University of South Carolina, Abhinav Rao and Don Rocky, studied data from adult patients who had undergone cirrhosis transplantation. The analysis included 937 people who were observed between 1987 and 2023. Patients who had an active hepatitis C infection at the time of surgery were not included in the main analysis.

After surgery, 107 participants developed cirrhosis — 11.4% of the entire study group. The median time from transplantation to its detection was 7.8 years. In 89 of these 107 patients, or 83.2%, the cause was the same liver disease that had previously led to the need for a transplant. Thus, we are not talking about the preservation of cirrhosis in a new organ, but about its development due to repeated damage to the donor liver.

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In which diseases was the risk higher?

The researchers found the highest proportion of recurrent cirrhosis among patients who had liver transplants due to autoimmune hepatitis and primary biliary cholangitis. In the first group, cirrhosis developed in 16 out of 55 people (29.1%), in the second — in 11 out of 52, or 21.2%. These indicators relate to patients with the appropriate initial diagnosis, and not to all participants in the study.

Autoimmune hepatitis is associated with an attack by the immune system on liver cells. In primary biliary cholangitis, the small bile ducts are affected. Transplantation allows you to replace an organ damaged as a result of these processes, but the possibility of a return of the disease requires further monitoring.

According to him, the results for patients with autoimmune hepatitis and primary biliary cholangitis emphasize the need to continue monitoring the liver after surgery.

When the cause is related to a new disease

Not every case of cirrhosis after transplantation was explained by the return of the previous disease. In 18 patients, or 1.9% of the entire group, it occurred for a different reason. Researchers call such cases de novo cirrhosis — that is, developed as a result of a new disease of the transplanted liver. Among 107 patients with cirrhosis after surgery, they accounted for 16.8%.

The most common cause in this group was chronic organ rejection: it was detected in nine out of 18 patients. In four more cases, cirrhosis was associated with metabolically associated steatohepatitis, an inflammatory liver disease that can be accompanied by fat accumulation and fibrosis. These are different processes, so it is possible to determine the cause of the deterioration of the liver after transplantation only with a medical examination.

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How is repeated cirrhosis related to survival

20 years after transplantation, the survival rate among patients who developed cirrhosis was 50.6%. Among those who did not have it, the figure reached 70.7%. The authors found a statistical association between cirrhosis of the transplanted liver and lower long-term survival. However, an observational study by itself does not allow us to assert that it is repeated cirrhosis that explains all the difference between the groups.

The work has other limitations: the data was obtained in one medical center, and the observation spans several decades. Therefore, the 11.4% figure should not be interpreted as an accurate individual risk for any person after transplantation. To verify the results, the authors consider further studies involving several centers to be necessary.

The main practical conclusion of the study concerns long-term follow-up. According to the recommendations of the European Association for the Study of the Liver, after transplantation, it is necessary to monitor the condition of the organ and take into account the disease that led to the operation, as well as possible new causes of liver damage. The examination and treatment plan is determined by the treating team in each case.