Abstract
De novo autoimmune hepatitis (AIH) is a rare graft dysfunction occurring in patients having undergone liver transplantation (LT) for causes other than AIH. We describe for the first time a case of de novo AIH associated with the administration of parathyroid hormone 1–34 [PTH(1–34)] and PTH(1–84) for severe osteoporosis. A 61-year-old woman was referred to our metabolic bone clinic due to severe osteoporosis, 3 years after LT for primary biliary cirrhosis. Initial treatment with PTH(1–34) led to asymptomatic hypertransaminasemia (two-fold the upper limit of normal), which normalized after drug discontinuation. A new flare of transaminases (three-fold the upper limit of normal) along with elevated alkaline phosphatase was observed after administration of PTH(1–84), which did not resolve after PTH(1–84) withdrawal. Subsequently, after exclusion of common causes of liver enzyme elevation, a liver biopsy was performed. Histological findings showed de novo AIH, which responded rapidly to treatment with methylprednisolone.
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References
Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, Hodsman AB, Eriksen EF, Ish-Shalom S, Genant HK, Wang O, Mitlak BH (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1441
Greenspan SL, Bone HG, Ettinger MP, Hanley DA, Lindsay R, Zanchetta JR, Blosch CM, Mathisen AL, Morris SA, Marriott TB (2007) Treatment of Osteoporosis with Parathyroid Hormone Study Group. Effect of recombinant human parathyroid hormone (1–84) on vertebral fracture and bone mineral density in postmenopausal women with osteoporosis: a randomized trial. Ann Intern Med 146:326–339
Black DM, Greenspan SL, Ensrud KE, Palermo L, McGowan JA, Lang TF, Garnero P, Bouxsein ML, Bilezikian JP, Rosen CJ (2003) PaTH Study Investigators. The effects of parathyroid hormone and alendronate alone or in combination in postmenopausal osteoporosis. N Engl J Med 349:1207–1215
Finkelstein JS, Hayes A, Hunzelman JL, Wyland JJ, Lee H, Neer RM (2003) The effects of parathyroid hormone, alendronate, or both in men with osteoporosis. N Engl J Med 349:1216–1226
Hodsman AB, Bauer DC, Dempster DW, Dian L, Hanley DA, Harris ST, Kendler DL, McClung MR, Miller PD, Olszynski WP, Orwoll E, Yuen CK (2005) Parathyroid hormone and teriparatide for the treatment of osteoporosis: a review of the evidence and suggested guidelines for its use. Endocr Rev 26:688–703
Saag KG, Shane E, Boonen S, Marín F, Donley DW, Taylor KA, Dalsky GP, Marcus R (2007) Teriparatide or alendronate in glucocorticoid-induced osteoporosis. N Engl J Med 357:2028–2039
Kerkar N, Hadzic N, Davies ET, Portmann B, Donaldson PT, Rela M, Heaton ND, Vergani D, Mieli-Vergani G (1998) De-novo autoimmune hepatitis after liver transplantation. Lancet 351:409–413
Yoshizawa K, Shirakawa H, Ichijo T, Umemura T, Tanaka E, Kiyosawa K, Imagawa E, Matsuda K, Hidaka E, Sano K, Nakazawa Y, Ikegami T, Hashikura Y, Miyagawa S, Ota M, Nakano M (2008) De novo autoimmune hepatitis following living-donor liver transplantation for primary biliary cirrhosis. Clin Transplant 22:385–390
Salcedo M, Rodríguez-Mahou M, Rodríguez-Sainz C, Rincón D, Alvarez E, Vicario JL, Catalina MV, Matilla A, Ripoll C, Clemente G, Bañares R (2009) Risk factors for developing de novo autoimmune hepatitis associated with anti-glutathione S-transferase T1 antibodies afterliver transplantation. Liver Transpl 15:530–539
Berardi S, Lodato F, Gramenzi A, D'Errico A, Lenzi M, Bontadini A, Morelli MC, Tame MR, Piscali F, Biseli M, Sama C, Mazzella G, Pinna AD, Grazi G, Bernardi M, Andreone P (2007) High incidence of allograft dysfunction in liver transplant patients treated with Peg-interferon alfa-2b and ribavirin for hepatitis C recurrence: possible de novo autoimmune hepatitis? Gut 56:237–242
Ebeling PR (2009) Approach to the patient with transplantation-related bone loss. J Clin Endocrinol Metab 94:1483–1490
Miyagawa-Hayashino A, Haga H, Egawa H, Hayashino Y, Sakurai T, Minamiguchi S, Tanaka K, Manabe T (2004) Outcome and risk factors of de novo autoimmune hepatitis in living-donor liver transplantation. Transplantation 78:128–135
Zhang Y, Wang B, Wang T (2010) De novo autoimmune hepatitis with centrilobular necrosis following liver transplantation for primary biliary cirrhosis: a case report. Transplant Proc 42:3854–3857
Salcedo M, Vaquero J, Bañares R, Rodríguez-Mahou M, Alvarez E, Vicario JL, Hernández-Albújar A, Tíscar JL, Rincón D, Alonso S, De Diego A, Clemente G (2002) Response to steroids in de novo autoimmune hepatitis after liver transplantation. Hepatology 35:349–356
Tan CK, Sian Ho JM (2001) Concurrent de novo autoimmune hepatitis and recurrence of primary biliary cirrhosis post-liver transplantation. Liver Transpl 7:461–465
Segre GV, Perkins AS, Witters LA, Potts J Jr (1981) Metabolism of parathyroid hormone by isolated rat Kupffer cells and hepatocytes. J Clin Invest 67:449–457
Mitnick MA, Grey A, Masiukiewicz U, Bartkiewicz M, Rios-Velez L, Friedman S, Xu L, Horowitz MC, Insogna K (2001) Parathyroid hormone induces hepatic production of bioactive interleukin-6 and its soluble receptor. Am J Physiol Endocrinol Metab 280:E405–E412
Vergani D, Mieli-Vergani G (2008) Aetiopathogenesis of autoimmune hepatitis. World J Gastroenterol 14:3306–3312
Wolters LM, Van Buuren HR (2005) Rosuvastatin-associated hepatitis with autoimmune features. Eur J Gastroenterol Hepatol 17:589–590
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Anagnostis, P., Efstathiadou, Z.A., Akriviadis, E. et al. De novo autoimmune hepatitis associated with PTH(1–34) and PTH(1–84) administration for severe osteoporosis in a liver transplant patient. Osteoporos Int 23, 2387–2391 (2012). https://doi.org/10.1007/s00198-011-1848-y
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DOI: https://doi.org/10.1007/s00198-011-1848-y