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Summary: Background: Azathioprine (AZA) and mercaptopurine (MP) are the cornerstone of steroid‐sparing strategies in autoimmune hepatitis (AIH). Up to 20% of patients do not tolerate or respond to these regimens. Aim: To evaluate retrospectively the tolerability and efficacy of tioguanine (thioguanine) (TG) therapy in selected patients with AIH and AIH variant syndromes. Methods: Records of 52 patients who received TG therapy were retrieved from nine hospitals in the Netherlands. Indications for TG treatment were intolerable side effects on AZA or MP (n = 38), insufficient response (n = 11) or first‐line treatment (n = 3). Treatment efficacy was defined as normalisation of serum aminotransferases and serum immunoglobulin G. Results: No serious adverse events occurred in patients treated with TG during a median follow‐up of 18 months (range 1‐194). Treatment was well tolerated in 41 patients (79%), whereas four had tolerable (8%) and seven (13%) intolerable side effects. Thirty‐eight patients were treated with TG after intolerable side effects on AZA or MP; 29 patients continued TG therapy of whom 24 (83%) achieved complete biochemical remission, four (14%) had incomplete and one (3%) had no response; nine discontinued treatment. Seven of 11 patients with insufficient response to AZA or MP were responsive to TG, three with complete and four with incomplete biochemical remission; four discontinued due to intolerance (n = 2) and non‐response (n = 2). TG was effective in all AIH patients as first‐line maintenance treatment. Conclusion: In our retrospective review of TG therapy in selected patients with AIH or AIH variants who previously failed on AZA or MP, TG appeared tolerable with biochemical efficacy. [ABSTRACT FROM AUTHOR]

Orthotopic liver transplantation ( OLT) with donation after circulatory death ( DCD) often leads to a higher first week peak alanine aminotransferase ( ALT) and a higher rate of biliary nonanastomotic strictures ( NAS) as compared to donation after brain death ( DBD). This retrospective study was to evaluate whether an association exists between peak ALT and the development of NAS in OLT with livers from DBD ( n = 399) or DCD ( n = 97) from two transplantation centers. Optimal cutoff value of peak ALT for risk of development of NAS post- DCD- OLT was 1300 IU/l. The 4-year cumulative incidence of NAS after DCD- OLT was 49.5% in patients with a high ALT peak post- OLT, compared with 11.3% in patients with a low ALT peak. ( P < 0.001). No relation between peak ALT and NAS was observed after DBD- OLT. Multivariate analysis revealed peak ALT ≥1300 IU/l [adjusted hazard ratio ( aHR) = 3.71, confidence interval ( CI) (1.26-10.91)] and donor age [ aHR = 1.04, CI 1.00-1.07] to be independently associated with development of NAS post- DCD- OLT. A peak ALT of <1300 IU/l carries a risk for NAS similar to DBD- OLT. Thus, in DCD- OLT, but not in DBD- OLT, peak ALT discriminates patients at high or low risk for NAS. [ABSTRACT FROM AUTHOR]