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Background: Liver Transplantation (LT) is the definitive treatment for Autoimmune Hepatitis (AIH) in patients with decompensated cirrhosis, liver failure and hepatocellular carcinoma. Outcomes of LT in AIH among black-Africans are not well-defined. We performed a single-center retrospective-review of adult LT patients. The study period was from 1st August 2004-31st August 2019. The primary aim was to document 1- & 5- year patient and graft survival. A secondary aim was to compare the survival of black-Africans to Caucasians. Data was analyzed using survival-analysis. Results: A total of 56 LT were performed for AIH. Sixty-seven percent (n = 38/56) had confirmed AIH on explant histology. Of these, the majority i.e., 79% (30/38) were female and 21% (8/38) were male. There were equal numbers of black-African 42% (n = 16/38) and Caucasian 42% (n = 16/38) patients. Rejection was four-times higher in black-Africans as compared to Caucasians. Forty-four percent (n = 17/38) had an acute rejection episode and 13% (5/38) had chronic rejection. Recurrence was found in four black-African females. Post-LT patient survival at 1- and 5- years was 86.5% and 80.7%, and graft survival was 94% and 70.8% respectively. The 5- year patient survival was insignificantly lower for black-Africans (73.9%) as compared to Caucasians (83.7%) (p - value 0.26, CI 6.3 - 12.2). Five-year graft survival was significantly lower among black-Africans (55%) as compared to Caucasians (84.8%) (p - value 0.003 CI 3.8 - 8.1) Conclusion: Black-Africans had a four-fold higher rate of rejection compared to Caucasians. Recurrent AIH was only found in patients of black ethnicity. Similar 1- & 5- year patient survival rates were observed between the two ethnicities. The 5-year graft survival among black-Africans was significantly lower than Caucasians.

Despite the fact that gynecologists were very early users of the operating microscope to observe the possible pathology of the cervical mucosa by brilliant lighting and magnification, the advent of in vitro fertilization (IVF) seems to have stopped this specialty from using the benefits of microsurgery in female tubal reconstruction. Now having performed and followed up for at least 2 years nearly 1000 microsurgical tubal reconstructions after sterilizations, with an endpoint being the birth of a baby in the time following, it is obvious that there are real benefits in pursuing these techniques, because no single IVF Unit in the world gets even half as many live birth results from their best practices. Apart from a genuine 82.7% baby result from all comers, of any child-bearing age and "sterilization age," with an ectopic pregnancy rate of1%, there are the benefits of (i) a single procedure, (ii) normal intercourse to become pregnant is the way to go, (iii) psychological trauma of the women involved is not a problem, and (iv) the next baby after the first is "free." In our opinion, it is sensible to scientifically attempt to reconstruct a deliberately blocked tube in the first instance because it is healthier (for mother and children), less expensive, more satisfying and psychologically acceptable, and is certainly far more reliable in its results than any other baby-promoting proceedure now available. It is regretted that gynecologists who flocked to workshops teaching microsurgical gynecological techniques before IVF was established now do not even seem to consider giving the operative reconstruction as a first alternative to their couples that come to them with sterilization as the cause of infertility.