Format

Send to

Choose Destination
J Hepatol. 2018 Nov 19. pii: S0168-8278(18)32538-8. doi: 10.1016/j.jhep.2018.11.006. [Epub ahead of print]

Grand Round: Autoimmune Hepatitis.

Author information

1
Centre for Liver and Gastroenterology Research, National Institute for Health Research (NIHR)Birmingham Biomedical Research Centre, UK; Liver Unit, University Hospitals Birmingham, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, UK.
2
Centre for Liver and Gastroenterology Research, National Institute for Health Research (NIHR)Birmingham Biomedical Research Centre, UK; Liver Unit, University Hospitals Birmingham, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, UK; Dept. of Cellular Pathology, University Hospitals Birmingham, UK.
3
Institute of Liver Studies, King's College Hospital, London, UK.
4
Liver Unit, Sheffield Teaching Hospitals Foundation Trust, UK.
5
Centre for Liver and Gastroenterology Research, National Institute for Health Research (NIHR)Birmingham Biomedical Research Centre, UK; Liver Unit, University Hospitals Birmingham, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, UK; Liver Unit, Sheffield Teaching Hospitals Foundation Trust, UK; Toronto Centre for Liver Disease, University of Toronto and University Health Network, Toronto, Canada. Electronic address: gideon.hirschfield@uhn.ca.

Abstract

Autoimmune hepatitis (AIH) is a corticosteroid responsive, autoimmune liver disease arising consequent to immunogenetic and environmental risk factors. The clinical course reflects relapsing and remitting, hepatocyte targeted, immunologic damage, countered by reparative responses to cell injury. Appropriate and timely immunosuppressive therapy drives disease into remission, albeit accompanied by inevitable side effects. Many challenges faced in the clinic reflect practice that must capture a heterogeneous disease presentation, course, and treatment response, as well as treatment tolerability. In this grand round we appraise the evidence supporting currently applied treatment approaches, address the impact of autoimmune liver disease 'crossover or overlap' presentations, explore important clinical correlates to immune-serological classifiers, and discuss the factors influencing choice of alternative therapy in difficult-to-treat situations.

PMID:
30465775
DOI:
10.1016/j.jhep.2018.11.006

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center