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Management of Difficult Cases of Autoimmune Hepatitis

  • Craig Lammert
  • Veronica M. Loy
  • Kiyoko Oshima
  • Samer GawriehEmail author
Liver (S Cotler and E Kallwitz, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Liver

Abstract

Autoimmune hepatitis (AIH) is a complex autoimmune disease characterized by immune-mediated destruction of hepatic parenchyma which can result in cirrhosis, liver failure, and death. Current American Association for the Study of Liver Diseases (AASLD) and European Association for the Study of Liver (EASL) guidelines recommend corticosteroids alone or in combination with azathioprine as first-line treatment strategies. However, a significant proportion of patients may not be able to tolerate or achieve complete biochemical response with these options. In this article, we discuss approaches to these patients and other challenging AIH patient groups such as the asymptomatic, pregnant, elderly, and liver transplant recipients.

Keywords

Autoimmune hepatitis Pregnancy Cirrhosis Nonstandard treatment Liver transplantation Refractory 

Abbreviations

AIH

Autoimmune hepatitis

AALSD

American Association for the Study of Liver Diseases

EASL

European Association for the Study of Liver

AZA

Azathioprine

AST

Aspartate aminotransferase

ALT

Alanine aminotransferase

IgG

Immunoglobulin G

6-MP

6-Mercaptopurine

MMF

Mycophenolate mofetil

PSC

Primary sclerosing cholangitis

PBC

Primary biliary cholangitis

6-TGN

6-Thioguanine nucleotide

6-MMP

6-Methyl mercaptopurine

mTOR

Mammalian target of rapamycin

INR

International normalized ratio

MELD

Model for end-stage liver disease

rAIH

Recurrent autoimmune hepatitis

HLA

Human leukocyte antigen

Notes

Compliance with Ethical Standards

Conflict of Interest

Craig Lammert reports grants from NIH, during the conduct of the study; Veronica M. Loy, Kiyoko Oshima, and Samer Gawrieh declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

With regard to the authors’ research cited in this paper, all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. In addition, all applicable international, national, and/or institutional guidelines for the care and use of animals were followed.

Grant Support

This publication was made possible with support provided to Craig Lammert from Grant Numbers KL2TR001106 and UL1TR001108 (A. Shekhar, PI) from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Craig Lammert
    • 1
  • Veronica M. Loy
    • 2
  • Kiyoko Oshima
    • 3
  • Samer Gawrieh
    • 1
    Email author
  1. 1.Division of Gastroenterology and HepatologyIndiana University School of MedicineIndianapolisUSA
  2. 2.Division of HepatologyLoyola UniversityMaywoodUSA
  3. 3.Department of PathologyMedical College of WisconsinMilwaukeeUSA

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