Journal
CLINICS IN LIVER DISEASE
Volume 19, Issue 1, Pages 57-79Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.cld.2014.09.004
Keywords
Autoimmune; Hepatitis; Diagnosis; Steroids; Suboptimal responses; Salvage therapies
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Autoimmune hepatitis is characterized by increased serum aminotransferase levels, autoantibodies, hypergammaglobulinemia, and interface hepatitis. Presentation can be acute, severe (fulminant), asymptomatic, or chronic. Diagnosis requires multiple findings and exclusion of similar diseases. Treatment with prednisone or prednisolone with azathioprine is recommended. Budesonide with azathioprine has normalized laboratory test with few side effects, but histologic resolution, durability of response, and target population are uncertain. Progressive worsening, incomplete improvement, drug intolerance, and relapse after drug withdrawal are suboptimal outcomes. Calcineurin inhibitors and mycophenolate mofetil are salvage agents in small series and liver transplantation is effective for liver failure.
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