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Reversibility of Hepatic Fibrosis in Autoimmune Hepatitis

Jean-Francois Dufour, MD; Ronald DeLellis, MD; and Marshall M. Kaplan, MD
[+] Article and Author Information

From New England Medical Center and Tufts University Medical School, Boston, Massachusetts. Grant Support: In part by National Institutes of Health training grant #T32-DK07701 and by the American Gastroenterology Association (Dr. Dufour). Requests for Reprints: Marshall M. Kaplan, MD, Box 233, Division of Gastroenterology, New England Medical Center, 750 Washington Street, Boston, MA 02111. Current Author Addresses: Dr. Dufour: Department of Pathology, New England Medical Center, 750 Washington Street, Boston, MA 02111.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1997;127(11):981-985. doi:10.7326/0003-4819-127-11-199712010-00006
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Background: Hepatic fibrosis and cirrhosis occur in many types of chronic liver injury and generally seem to be irreversible.

Objective: To determine whether cirrhosis caused by autoimmune hepatitis can be reversible.

Design: Retrospective study.

Patients: Eight patients with autoimmune hepatitis and cirrhosis who responded to medical therapy and had follow-up liver biopsy while in clinical and biochemical remission.

Measurements: Biopsy specimens were randomly coded in an unpaired manner according to patient and were read independently by two pathologists using the Knodell scoring system.

Results: The median alanine aminotransferase level decreased from 10.30 µkat/L to 0.37 µkat/L, the median serum bilirubin level decreased from 70 µmol/L to 10 µmol/L, and the median serum albumin level increased from 34 g/L to 43 g/L. Cirrhosis, extensive fibrosis, or both were present in all patients at diagnosis but were not present on follow-up liver biopsy. The median Knodell score decreased from 14.0 to 1.3, and the median fibrosis score decreased from 3.3 to 0.8.

Conclusion: Hepatic fibrosis and cirrhosis may be reversible in some patients in whom autoimmune hepatitis responds to treatment.

Figures

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Figure 1.
Liver biopsy specimens.

A. Patient 1. Surgical liver biopsy specimen obtained at diagnosis. The liver was reported to be macroscopically nodular, and there are extensive portal fibrosis and linkage of portal triads by bands of connective tissue. (Masson trichrome; original magnification, x74.) B. Patient 1. Percutaneous liver biopsy specimen obtained 10 years after diagnosis. The parenchyma and portal triads are normal. (Masson trichrome; original magnification, x74.) C. Patient 2. Percutaneous liver biopsy specimen obtained 2.5 years after diagnosis and just before compliance with treatment. There is obvious cirrhosis with islands of parenchyma between bands of connective tissue. (Masson trichrome; original magnification, x74.) D. Patient 2. Percutaneous liver biopsy specimen obtained after 5.5 years of immunosuppressive therapy. Results were normal except for minimal portal fibrosis. (Gomori trichrome; original magnification, x74.) E. Patient 3. Percutaneous liver biopsy specimen obtained before treatment. There are dense bands of connective tissue that disrupt parenchyma and extensive piecemeal necrosis. (Masson trichrome; original magnification, x74.) F. Patient 3. Percutaneous liver biopsy done after 2 years of prednisone treatment. Portal triads are minimally enlarged, but no piecemeal necrosis or bridging fibrosis is seen. (Gomori trichrome; initial magnification, x74.).

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