Natural History and Treatment Outcomes of Severe Autoimmune Hepatitis

Sonthalia, Nikhil; Rathi, Pravin; Jain, Shreepal; Surude, Ravindra; Mohite, Ashok; Pawar, Sunil; Contractor, Qais

doi:10.1097/mcg.0000000000000805

Cited by 32 publications

(39 citation statements)

References 35 publications

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“…This finding was corroborated in a French study, which used the same criteria to define AS‐AIH, where 10/17 (59%) patients developed ALF . A study from India suggested that the percentage of patients with AS‐AIH and ALF may be smaller …”

Section: Definitionsmentioning

confidence: 65%

“…Sonthalia et al compared a cohort of patients with severe AIH (including acute‐on‐chronic disease) and nonsevere AIH. The patients with severe AIH had histological features of centrilobular confluent necrosis without portal inflammation; however, these changes were also present in the nonsevere group . Other studies also identified centrilobular necrosis as a marker of severity in early and chronic AIH.…”

Section: Epidemiologymentioning

confidence: 92%

“…Once the IAIHG recommendations of titer strengths were applied, only 66% had “positive” autoantibodies . Seronegativity appears to be a feature of severe AIH …”

Section: Epidemiologymentioning

confidence: 99%

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Acute Severe Autoimmune Hepatitis: Corticosteroids or Liver Transplantation?

et al. 2019

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Acute severe presentations of autoimmune hepatitis (AIH) represent a challenge for the transplant community. As a disease, it is poorly characterized, and there is a weak evidence base to guide diagnosis and treatment. Early identification of acute severe AIH is key because it determines the initiation of corticosteroids, which can be lifesaving. However, their use in this setting remains controversial. The Model for End‐Stage Liver Disease score, severity of coagulopathy, and grade of encephalopathy may be predictors of outcome with corticosteroid therapy. The optimal timing of liver transplantation (LT) can be difficult to determine and, as such, the decision to proceed to transplantation should not be delayed by protracted courses of corticosteroids. The aim of this review is to better characterize this subset of patients; to differentiate them clinically, serologically, and histologically from chronic AIH and other causes of acute liver failure; and to present the role, predictors, and optimal timings of corticosteroid therapy and LT. Although this review is specific to adults, many principles hold true for the pediatric population.

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Section: Definitionsmentioning

confidence: 65%

Section: Epidemiologymentioning

confidence: 92%

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Acute Severe Autoimmune Hepatitis: Corticosteroids or Liver Transplantation?

et al. 2019

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“…On the other hand, there are a few retrospective studies which have shown liver fibrosis to be an independent predictor of nonresponse to corticosteroids in AIH. A recent study by Sonthalia et al has shown hepatic encephalopathy to be one of the predictive markers of nonresponse in acute‐severe AIH …”

Section: Discussionmentioning

confidence: 99%

Flare of Autoimmune Hepatitis Causing Acute on Chronic Liver Failure: Diagnosis and Response to Corticosteroid Therapy

Anand¹,

Choudhury²,

Bihari³

et al. 2019

Hepatology

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“…Acute AIH was defined as a patient having normal liver function or symptoms for >12 months or 26 weeks previously and only recently found to have abnormal function or symptoms for the first time. 7,8 Moreover, Dohmen et al…”

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confidence: 99%