Transplant and Autoimmune Diseases

The three main autoimmune liver diseases in the context of end-stage liver disease are primary sclerosing cholangitis (PSC), autoimmune hepatitis (AIH), and primary biliary cholangitis (PBC) and all can be treated by liver transplantation (LT). Each of the three liver diseases accounts for 3–8% of the indications for LT according to the European Liver Transplant Registry and UNOS. The greatest challenge is not only to determine who will need a transplant, but to decide when the transplant will be needed. Graft and patient survival after LT are excellent, reaching 70–80% at 5 years. Quality of life is significantly improved post-transplant as patients report better overall health and greater ability to carry on daily activities with minimal or no symptoms. An important point in the management of patients underwent LT for cholestatic liver diseases is the risk of disease recurrence after LT, even in a small group. In this chapter, all the mentioned topics will be explained.