Recurrence of autoimmune hepatitis following liver transplantation.

isease recurrence after liver transplantation is D increasingly recognized as a major cause of graft damage with accompanying patient morbidity and, in certain viral and malignant disorders, mortality. Among the immune-related transplantation indications, recurrence is less well documented and not presently considered a major cause of graft dysfunction. Patients with end-stage autoimmune hepatitis (AIH) accounted for 2.6% of recipients in the European liver transplant registry.’ This disorder, which is characterized by specific human leucocyte antigen (HIA) associations and disordered immunoregulation, frequently responds to immunosuppression. In particular, corticosteroids and azathioprine can induce clinical remission and remain the mainstay of current treatment protocols with anecdotal reports of response to cyclosporin A (CyA) in certain case^.^-^ The use of these particular agents in conventional ‘triple therapy’ maintenance-immunosuppression regimens following transplantation to control liver allograft rejection may, by secondarily inhibiting the autoimmune process, explain why there are so few reports of recurrence of AIH and other immunerelated liver disorders. We were the first to report recurrence of this disorder in 1984, with a larger series also reported from the University of Pittsb~rgh.~.~ In this report, we describe severe recurrence of AIH in the primary liver graft of a recipient 10 years after transplantation who had received maintenance immunosuppression consisting of CyA alone. This case as well as providing further evidence for recurrence of this disorder additionally highlights the necessity for indefinite close clinical and pathological surveillance after transplantation. The potential haz