Assessment of the Factors That Predict Post-Transplant Mortality in Autoimmune Liver Disease Recipients.

Background and

Objectives

Autoimmune liver diseases (AILD), including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC), frequently lead to end-stage liver disease requiring transplantation. The factors associated with post-transplant mortality in recipients with autoimmune liver diseases (AILDs) remain incompletely characterized. We aimed to evaluate the clinical, laboratory, disease-related, and comorbidity factors associated with post-transplant mortality in this population. Materials and

Methods

This retrospective cohort study included 94 AILD recipients (26 AIH, 28 PBC, 40 PSC) transplanted between 2004 and 2025. We analyzed clinical, laboratory, transplant-related variables, and comorbidities (Charlson Comorbidity Index [CCI]). We assessed survival using Kaplan-Meier and Cox regression analyses. Early mortality was defined as death within 90 days after transplantation.

Results

Overall mortality was 17.0% (16/94). Mortality rates were 28.6%, 15.4%, and 10.0% in PBC, AIH, and PSC, respectively, without a statistically significant between-group difference (p = 0.313). Among 93 recipients with ascertainable follow-up, 8 deaths occurred within 90 days (8.6%). In the exploratory Cox regression analysis, preoperative creatinine showed the strongest association with mortality (HR = 8.67 per 1 mg/dL increase, p < 0.001). Transplant age (HR = 1.06 per year, p = 0.010) and disease duration (HR = 1.09 per year, p = 0.004) were also associated with mortality. These associations remained statistically significant in the exploratory multivariable model. MELD, MELD-Na, and MELD 3.0 were not significantly associated with post-transplant mortality in this cohort. Because of the limited number of deaths, the multivariable findings should be regarded as hypothesis-generating. Documented and treated acute rejection was recorded in 32.2% of recipients. In an exploratory analysis, higher BMI was associated with increased odds of this outcome; however, histopathological confirmation was not systematically available.

Conclusions

In this single-center AILD cohort, preoperative serum creatinine, disease duration, age at transplantation, and comorbidity burden showed associations with post-transplant mortality, whereas the evaluated liver severity scores were not significantly associated with mortality. These exploratory findings require confirmation in larger multicenter cohorts before they can be incorporated into post-transplant risk-stratification models.