Role of Histopathology in Autoimmune Hepatitis

Tiniakos, Dina; Brain, John; Bury, Yvonne

doi:10.1159/000440747

Cited by 95 publications

(82 citation statements)

References 61 publications

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“…In the first biopsy during transplantation, the patient had only had centrilobular necrosis. These findings are consistent with the known idea that centrilobular necrosis can be the only pathologic feature in up to 2-3% of patients presenting with AIH flares [11][12][13]. Moreover, the patient had positive antimitochondrial antibodies, which, while being more specific for primary biliary cholangitis, might be associated with AIH [14].…”

Section: Discussionsupporting

confidence: 90%

Auxiliary Liver Transplantation as a Transient Treatment for Acute Liver Failure: Two Cases

Perdigoto

Tomé

Diogo

et al. 2018

GE Port J Gastroenterol

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Introduction: Acute liver failure is an uncommon condition associated with a high mortality. Most patients do not survive without liver transplantation. In the last decades, auxiliary liver transplantation has emerged as a therapeutic option. Clinical Case: The authors present two cases of acute liver failure that required liver transplantation. Given the patients' young age and the preserved macroscopic liver pattern evaluated in surgery, auxiliary liver transplantation was executed using different surgical approaches. Afterwards, following confirmed full native liver regeneration, the patients were submitted to auxiliary liver hepatectomy, which was accomplished without complications. Conclusion: Auxiliary liver transplantation can be regarded as an effective temporary treatment for acute liver failure in selected cases, allowing an immunosuppression-free life. tectomia do fígado auxiliar. Conclusão: O transplante hepático auxiliar constitui uma terapêutica transitória eficaz em alguns casos de falência hepática aguda, permitindo um futuro isento de imunossupressão.

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Section: Discussionsupporting

confidence: 90%

Auxiliary Liver Transplantation as a Transient Treatment for Acute Liver Failure: Two Cases

Perdigoto

Tomé

Diogo

et al. 2018

GE Port J Gastroenterol

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“…Emperipolesis has been widely described in classic AIH and included in the simplified International Autoimmune Hepatitis Group scoring system (2008) 41 69. The presence of emperipolesis indicates a close immune interaction between lymphocytes and hepatocytes, which may subsequently induce hepatocyte apoptosis and has been proposed as an additional mechanism of autoimmune-mediated liver injury in AIH.…”

Section: Discussionmentioning

confidence: 99%

Acute presentation of autoimmune hepatitis: a multicentre study with detailed histological evaluation in a large cohort of patients

et al. 2017

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The acute presentation of AIH represents the entire histological spectrum of acute hepatitis and chronic hepatitis with various activity grades and fibrosis stages that clinically correspond to acute-onset AIH and acute exacerbation of classic AIH, respectively. Although there are no pathognomonic features for the pathological diagnosis, the prominent presence of lobular and perivenular necroinflammatory activity, pigmented macrophages and cobblestone appearance of hepatocytes in addition to the classic AIH features, such as plasma cell infiltration and emperipolesis, are useful for the pathological diagnosis of the acute presentation of AIH.

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“…Therefore, liver biopsy is essential for establishing the diagnosis of AIH. It should be kept in mind that CZN is part of the histological spectrum of AIH, even if interface hepatitis is not observed 11. Thus, a liver biopsy may provide essential information regarding the diagnosis of AIH.…”

Section: Pitfalls In the Diagnosis Of Classical Aihmentioning

confidence: 99%

Autoimmune hepatitis: current challenges and future prospects

Aizawa¹,

Hokari²

2017

CEG

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Autoimmune hepatitis (AIH) is a chronic progressive liver disease characterized by high levels of aminotransferases and autoantibodies, hypergammaglobulinemia, and interface hepatitis. AIH affects all races and all ages worldwide, regardless of sex, although a preponderance of females is a constant finding. The etiology of AIH has not been completely elucidated, but immunogenetic background and environmental parameters may contribute to its development. The most important genetic factor is human leukocyte antigens (HLAs), especially HLA-DR, whereas the role of environmental factors is not completely understood. Immunologically, disruption of the immune tolerance to autologous liver antigens may be a trigger of AIH. The diagnosis of classical AIH is fairly easy, though not without pitfalls. In contrast, the diagnosis of atypical AIH poses great challenges. There is confusion as to the definition of the disease entity and its boundaries in the diagnosis of overlap syndrome, drug-induced autoimmune hepatitis, and AIH with concomitant nonalcoholic fatty liver disease (NAFLD) or chronic hepatitis C. Centrilobular zonal necrosis is now included in the histological spectrum of AIH. However, the definition and the significance of AIH presenting with centrilobular zonal necrosis have not been examined extensively. In ~20% of AIH patients who are treated for the first time with standard therapy, remission is not achieved. The development of more effective and better tolerated novel therapies is an urgent need. In this review, we discuss the current challenges and the future prospects in relation to the diagnosis and treatment of AIH, which have been attracting considerable recent attention.

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Role of Histopathology in Autoimmune Hepatitis

Cited by 95 publications

References 61 publications

Auxiliary Liver Transplantation as a Transient Treatment for Acute Liver Failure: Two Cases

Auxiliary Liver Transplantation as a Transient Treatment for Acute Liver Failure: Two Cases

Acute presentation of autoimmune hepatitis: a multicentre study with detailed histological evaluation in a large cohort of patients

Autoimmune hepatitis: current challenges and future prospects

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