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

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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.

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