Factors Predicting Relapse and Poor Outcome in Type I Autoimmune Hepatitis: Role of Cirrhosis Development, Patterns of Transaminases During Remission and Plasma Cell Activity in the Liver Biopsy

Verma, Sumita; Gunuwan, Basuki; Mendler, Michel; Govindrajan, Sugantha; Redeker, Allan G.

doi:10.1111/j.1572-0241.2004.30457.x

Cited by 178 publications

(155 citation statements)

References 24 publications

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“…By controlling for multiple variables in a time-dependent manner, our survival data are more robust, albeit apparently less optimistic. A recent study by Verma et al 25 also found that patients with cirrhosis at presentation were more likely to die or develop complications of their liver disease during follow-up.…”

Section: Discussionmentioning

confidence: 97%

Autoimmune hepatitis: Effect of symptoms and cirrhosis on natural history and outcome

et al. 2005

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Although the natural history of autoimmune hepatitis (AIH) has been characterized, little is known about patients who present asymptomatically. Consequently, whether they require immunosuppressive therapy with its associated complications is unclear. To compare the natural history of asymptomatic AIH with symptomatic AIH, a large cohort of patients from a single center was examined. All patients with a clinical diagnosis of AIH were reassessed using the revised criteria of the International Autoimmune Hepatitis Group. Liver histology, response to therapy, and survival were assessed. Patients asymptomatic at presentation (n ‫؍‬ 31) had lower serum aminotransferase, bilirubin, and immunoglobulin G (IgG) values at baseline. Half of the asymptomatic patients received no therapy, and their survival was no different from that of the total cohort. Ten-year survival was 80.0% (62.5%-97.5%) in the asymptomatic group and 83.8% (75.1%-92.6%) in the symptomatic patients (P ‫؍‬ NS). Survival to liver-related endpoints at 10 years was similar in both groups: 89.5% (

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Section: Discussionmentioning

confidence: 97%

Autoimmune hepatitis: Effect of symptoms and cirrhosis on natural history and outcome

et al. 2005

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“…Similarly, although there is an occasional study reporting decrease in hepatic fibrosis in autoimmune hepatitis, a case series showed the development of cirrhosis to be associated with less response to therapy [67].…”

Section: Reversibility Of Hepatic Fibrosismentioning

confidence: 99%

Liver fibrosis: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL)

et al. 2008

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“…Mild portal inflammatory changes frequently persist and do not appear to be associated with an adverse outcome. However, the presence of portal plasma cells may be associated with an increased risk of relapse after drug withdrawal [37,109].…”

Section: When To Repeat Liver Biopsy?mentioning

confidence: 99%

“…Up to 30% of adult patients have histological features of cirrhosis at diagnosis [18,36] and progression of fibrosis can occur in patients with inflammatory activity despite steroid therapy [18]. The presence of cirrhosis at baseline significantly increases the risk of subsequent death or liver transplantation [18,37]. The risk of hepatocellular carcinoma (HCC) in autoimmune liver disease is associated with the development of cirrhosis and is no greater than in other non-viral causes of cirrhosis [38].…”

Section: Natural Historymentioning

confidence: 99%

Autoimmune hepatitis: new paradigms in the pathogenesis, diagnosis, and management

2010

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Autoimmune hepatitis (AIH), primary biliary cirrhosis, and primary sclerosing cholangitis are the three major autoimmune diseases affecting the liver, and of these three, AIH is the most typical autoimmune disease being characterized by a T-cell-rich infiltrate, raised circulating c-globulins, autoantibodies, HLA associations, and links with other autoimmune diseases. It is the only one, of the three diseases, that responds well to immunosuppressive therapy. AIH is caused by dysregulation of immunoregulatory networks and the consequent emergence of autoreactive T cells that orchestrate a progressive destruction of hepatocytes leading untreated to liver failure. T cells play a major role in the immunopathogenesis, and both CD4? and CD8? T cells are involved together with effector responses mediated by NK cells, cd T cells, and macrophages. A number of triggering factors have been proposed including viruses, xenobiotics, and drugs, but none have been conclusively shown to be involved in pathogenesis.

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Factors Predicting Relapse and Poor Outcome in Type I Autoimmune Hepatitis: Role of Cirrhosis Development, Patterns of Transaminases During Remission and Plasma Cell Activity in the Liver Biopsy

Abstract: Seventy percent of patients with AIH relapse upon drug cessation. Time to remission > or = 5 months, ATI > or = 2 and PPCS > or = 3 were associated with > 90% probability of relapse. Factors predicting poor outcome were globulins at onset and cirrhosis development.

Cited by 178 publications

References 24 publications

Autoimmune hepatitis: Effect of symptoms and cirrhosis on natural history and outcome

Autoimmune hepatitis: Effect of symptoms and cirrhosis on natural history and outcome

Liver fibrosis: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL)

Autoimmune hepatitis: new paradigms in the pathogenesis, diagnosis, and management

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