Reviewed By: Pramod Kerkar, MD, FFARCSI

Is Autoimmune Hepatitis Serious?

Autoimmune hepatitis is a serious disorder as there is no single direct diagnostic test. The diagnosis of autoimmune hepatitis is best achieved through a combination of clinical, laboratory, and imaging findings after eliminating other etiological factors such as viral, hereditary, metabolic, cholestatic, and drug-induced diseases. High transaminase and immunoglobulin G (IgG) levels, positive autoantibodies, and interface hepatitis are some of the characterized factors of this chronic inflammatory liver disease. If untreated, it has a poor prognosis. This inflammatory disease of the liver can lead to acute liver failure and end-stage liver disease requiring liver transplantation.

Is Autoimmune Hepatitis Serious?

Recurrent Autoimmune Hepatitis

Approximately 20% to 30% of patients undergoing liver transplantation for autoimmune hepatitis develop features of the recurrent disease. Diagnostic criteria for recurrent autoimmune hepatitis are similar to those used in the non-transplanted liver but more difficult to apply in the liver allograft. The reasons for recurrent autoimmune hepatitis are unknown. The frequency of recurrent autoimmune hepatitis increases with time after transplantation from 12% at 1 year to 36% after 5 years, 14 and progression to cirrhosis and graft failure is possible.

Autoimmune Hepatitis different forms

Patients may have acute, acute severe (fulminant), or sometimes asymptomatic state of autoimmune hepatitis. An acute presentation occurs in 25% to 75% of patients with autoimmune hepatitis, and an acute severe (fulminant) presentation, characterized by the development of hepatic encephalopathy within 26 weeks of disease discovery, occurs in 3% to 6% of North American and European patients. Whereas asymptomatic cases are seen in 25% to 34% of patients, and the diagnosis must be considered in all individuals with newly discovered mild liver test abnormalities. Symptoms of asymptomatic develop in 26% to 70% of patients within 2 to 120 months (mean interval, 32 months).

Prevalence of Autoimmune Hepatitis

The disease has a universal distribution, can affect any age, either females or males, irrespective of the ethnicity of the affected individual. Based on limited epidemiologic studies, the incidence of type 1 autoimmune hepatitis among Caucasoid populations of Europe and North America ranges from 0.1 to 1.9/100,000/year. Alaskan natives have a high frequency of acute icteric disease at the disease onset, blacks carry a more progressive disease than non-blacks, and patients of Hispanic ancestry usually have an advanced disease at onset with a high prevalence of cirrhosis. On the other hand, individuals of Asian background demonstrate very poor survival outcomes. The disease is considerably less frequent in Japan.

Liver-Related Death

Long-term survival was reduced in patients with autoimmune hepatitis. No gender difference regarding prognosis was seen but one study identified that men died younger than women, probably as a result of the earlier onset of disease. Cirrhosis at diagnosis was a risk factor for poor prognosis and the overall risk of liver-related death was increased. Majority of the death cases included hepatocellular carcinoma.

Conclusion

The diagnosis of autoimmune hepatitis is best achieved through a combination of clinical, laboratory, and imaging findings after eliminating other etiological factors such as viral, hereditary, metabolic, cholestatic, and drug-induced diseases. Long-term survival was reduced in patients with autoimmune hepatitis. Cirrhosis at diagnosis was a risk factor for poor prognosis and the overall risk of liver-related death was increased. This inflammatory disease of the liver can lead to acute liver failure and end-stage liver disease requiring liver transplantation. Approximately 20% to 30% of patients undergoing liver transplantation for autoimmune hepatitis develop features of the recurrent disease.

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Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: July 10, 2018

This article does not provide medical advice. See disclaimer

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