Recurrence of autoimmune liver diseases after liver transplantation: exploratory analysis of a pooled Latin American cohort

Structured Abstract Introduction and Objectives Autoimmune liver diseases (AILDs) are an increasingly frequent indication for liver transplantation in Latin America. Recurrence after transplantation may affect graft function and long-term outcomes; however, recurrence patterns and associated factors remain incompletely characterized. We aimed to describe recurrence after liver transplantation in a pooled cohort of AILDs and to explore factors associated with recurrence, overall survival, and retransplantation. Patients and Methods We conducted a retrospective cohort study of adult patients with AILDs who underwent liver transplantation between 2005 and 2023. Recurrence was defined using biochemical, serological, and histological criteria. Associations were evaluated using logistic regression and Kaplan–Meier survival analyses. Results A total of 154 patients were included, of whom 64 (41.5%) developed recurrence after a median of 49 months (IQR 21.2–91). In the primary analysis, recurrence was associated with elevated pre-transplant ALT and AST levels and a history of acute rejection. In sensitivity analyses, elevated AST levels showed the most consistent association with recurrence. Associations involving ALT were attenuated after subgroup restriction, whereas the association with acute rejection varied across analyses. No significant differences were observed in overall survival or retransplantation rates between patients with and without recurrence. Conclusions Recurrence after liver transplantation was frequent and varied across autoimmune liver disease subtypes. Elevated pre-transplant AST levels were consistently associated with recurrence across exploratory analyses. Despite the high frequency of recurrence, no significant association was observed with impaired overall survival or increased retransplantation. These findings require confirmation in larger multicenter studies with disease-specific analyses.