Autoimmune Hepatitis

Abstract

Background:  Advanced hepatic fibrosis and cirrhosis has generally been considered to be irreversible. The aim of this study was to determine whether cirrhosis is reversible.   

Methods:  Seven patients with autoimmune hepatitis with histologic evidence of cirrhosis were enrolled. After treatment, they had follow-up liver biopsy while in clinical and biochemical remission. Biopsy specimens were randomly coded in unpaired manner according to patient and were read independently by two pathologists using the modified hepatitis activity index (with a maximum stage of 6).

Results: Three patients still had extensive fibrosis in the second liver biopsy. But four patients had almost total regression of their liver fibrosis. In the latter patients, the mean alanine aminotransferase level decreased from 776.3 U/L to 23 U/L. The mean bilirubin level decreased from 5.85 mg/dL, to 0.98 mg/dL. Extensive fibrosis or cirrhosis were present in all patients at diagnosis but were not present on follow-up liver biopsy. The mean fibrosis score decreased from 5.88 to 0.5 (P=0.0002), and the mean grading score from 11.38 to 2.5 (P=0.0008).

Conclusion: Frank cirrhosis due to autoimmune hepatitis may be reversible in some patients who respond to treatment.