Authors: Albert J Czaja
Publish Date: 2012/10/23
Volume: 58, Issue: 4, Pages: 897-914
Abstract
Autoimmune hepatitis frequently has an abrupt onset of symptoms and it can present with acute liver failure The abrupt presentation can indicate spontaneous exacerbation of a preexistent chronic disease newly created disease a superimposed infectious or toxic injury or new disease after viral infection drug therapy or liver transplantation Deficiencies in the classical phenotype may include a low serum immunoglobulin G level and low or absent titers of the conventional autoantibodies The original revised diagnostic scoring system of the International Autoimmune Hepatitis Group can guide the diagnostic evaluation but low scores do not preclude the diagnosis Liver tissue examination is valuable to exclude viralrelated or druginduced liver injury and support the diagnosis by demonstrating centrilobular necrosis usually with interface hepatitis lymphoplasmacytic infiltration hepatocyte rosettes and fibrosis Conventional therapy with prednisone and azathioprine induces clinical and laboratory improvement in 68–75 of patients with acute presentations and high dose prednisone or prednisolone preferred drug is effective in 20–100 of patients with acute severe fulminant presentations Failure to improve or worsening of any clinical or laboratory feature within 2 weeks of treatment or worsening of a mathematical model of endstage liver disease within 7 days justifies liver transplantation in acute liver failure Liver transplantation for acute severe fulminant autoimmune hepatitis is as successful as liver transplantation for autoimmune hepatitis with a chronic presentation and other types of acute liver failure patient survival 1 year 80–94 Liver transplantation should not be delayed or superseded by protracted corticosteroid therapy or the empiric institution of nonstandard medications
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