The utility of repeat liver biopsy in autoimmune hepatitis: a series of 20 consecutive cases

Putra, Juan; Toor, Arifa; Suriawinata, Arief A.

doi:10.1016/j.pathol.2016.05.001

Cited by 10 publications

(7 citation statements)

References 18 publications

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“…Other studies have shown that histological remission might not correlate well with biochemical remission in AIH patients leading to a second biopsy prior to a treatment-withdrawal decision, similarly to the study conducted by Putra et al. [ 7 ], although, in that study, only 6 out of the 20 patients enrolled in the study had biopsy for the treatment-withdrawal decision, and approximately 40% underwent the biopsy for elevated liver enzymes, which was different from our study population. The lag period between the biochemical and histological remission usually varies from 3 to 8 months [ 8 ].…”

Section: Discussionsupporting

confidence: 41%

Well-controlled autoimmune hepatitis treatment withdrawal may be safely accomplished without liver-biopsy guidance

Guirguis¹,

Alonso

López

et al. 2018

Gastroenterology Report

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BackgroundAutoimmune hepatitis may flare up after treatment withdrawal, especially in those who had not achieved histological remission but had normal liver enzymes. The European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Disease (AASLD) Guidelines recommend performing liver biopsy before treatment withdrawal. The aim of the study is to define the outcome of treatment withdrawal in adults with well-controlled disease for 2 years with and without liver-biopsy guidance.MethodsA retrospective observational study was conducted on biopsy-proven autoimmune hepatitis patients who were treated for 2 years and with persistently normal aspartate aminotransferase (AST) and alanine aminotransferase (ALT) or nearly so for 6 months prior to treatment withdrawal. Exclusions were: juvenile onset autoimmune hepatitis and prior treatment or use of agents other than corticosteroids and azathioprine. The primary endpoint was to define freedom from flare-ups for 1 year after treatment withdrawal.ResultsThirty-four consecutive subjects meeting study criteria were identified. Treatment withdrawal was accomplished in 24 subjects without liver-biopsy guidance and 10 had pre-treatment withdrawal liver biopsy. Demographics, immunosuppressive usage, pre-treatment cirrhosis and pre-treatment liver enzymes were similar between the two groups, and 25% had an enzyme flare-up within 12 months after treatment withdrawal, which was similar in the two groups (20.8 vs 30.0%, P = 0.57).ConclusionsAdults with autoimmune hepatitis and excellent response to therapy for 2 years are candidates for treatment withdrawal without the need for liver biopsy.

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Section: Discussionsupporting

confidence: 41%

Well-controlled autoimmune hepatitis treatment withdrawal may be safely accomplished without liver-biopsy guidance

Guirguis¹,

Alonso

López

et al. 2018

Gastroenterology Report

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“…[61] A repeat liver biopsy is not always needed but should be considered if there is an increase in liver enzymes in spite of adequate immunosuppression and prior to discontinuation of treatment. [62] The presence of portal plasma cell infiltrates on liver biopsy prior to withdrawal of treatment was found to predict relapse with a sensitivity of 31% and positive predictive value of 92%. [63]…”

Section: Diagnosismentioning

confidence: 99%

The Saudi association for the study of liver diseases and transplantation clinical practice guidelines for management of autoimmune hepatitis

Aljumah

Jarallah

Albenmousa

et al. 2018

Saudi J Gastroenterol

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“…The analysis of a large cohort of 2413 patients showed that the liver biopsy changed the diagnosis in 31.2% of cases and was a safe procedure [8, 9]. The main indicators for the liver biopsy include diagnostic and prognostic purposes, evaluating disease severity and monitoring response to treatment, together with the diagnostic performance of non-invasive methods [10–12]. It is an irreplaceable tool in diagnosis and follow-up of several chronic liver diseases [13].…”

Section: Discussionmentioning

confidence: 99%

Hepatopathy of unknown etiology – is liver biopsy a good tool in differential diagnosis?

Jabłońska¹,

Cielecka-Kuszyk

Mikuła³

et al. 2019

aoms

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IntroductionLiver biopsy is a well-known method for the diagnosis and evaluation of chronic diffuse liver diseases, especially among patients with “hepatopathy of unknown origin”.Material and methodsIn the years 2014–2015 we performed 259 liver biopsies in 28 patients (22 females, 6 males, aged 18–65 years, mean: 45 years) with an initial diagnosis of “hepatopathy of unknown origin”. The liver biopsies of these 28 patients were revised by two independent pathologists.ResultsHistopathological features of autoimmune conditions were found in 11 cases, steatohepatitis with/without Mallory bodies in 7, simple steatosis without inflammation in 2 cases. In the other 8 cases the histopathological features were non-specific but pointed to vanishing bile duct syndrome, hemochromatosis, acute inflammation or fibrosis without inflammation. Surprisingly, only mild fibrosis without inflammatory infiltrates was present in one patient with a high titer of antinuclear antibodies (ANA > 1 : 3200). Mild cholestasis with bilirubinostasis was found in 4 cases. One patient had prominent lobular iron deposits and is now under observation for hemochromatosis. Vanishing bile duct syndrome as ductopenia without any signs of inflammation was found in one patient with suspicion of primary biliary cirrhosis. In one liver biopsy specimen we found normal liver architecture without inflammation or steatosis in a patient with elevated ALT and GGT, negative for viral antibodies and autoantibodies.ConclusionsLiver biopsy – despite the increasing access to new, non-invasive methods – remains a useful method in the differential diagnosis of liver diseases.

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The utility of repeat liver biopsy in autoimmune hepatitis: a series of 20 consecutive cases

Cited by 10 publications

References 18 publications

Well-controlled autoimmune hepatitis treatment withdrawal may be safely accomplished without liver-biopsy guidance

Well-controlled autoimmune hepatitis treatment withdrawal may be safely accomplished without liver-biopsy guidance

The Saudi association for the study of liver diseases and transplantation clinical practice guidelines for management of autoimmune hepatitis

Hepatopathy of unknown etiology – is liver biopsy a good tool in differential diagnosis?

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