Treatment of patients with severe autoimmune hepatitis.

Autoimmune hepatitis (AIH) is a progressive inflammatory diseases of unknown origin that is characterised by a necro-inflammatory and fibrotic process and may result in liver failure or uncompensated liver cirrhosis. Normally AIH is responsive to immunosuppressive therapy, and treatment aims to alleviate clinical symptoms, and induce biochemical and histological remission. This short review aims to describe standard medical treatment (SMT) and the experience with newer immunosuppressive drugs in patients refractory or intolerant to SMT. In such cases calcineurin inhibitors (i.e, ciclosporine and tacrolimus) might salvage patients from transplantation. Mycophenolate mofetil may also improve liver tests and reduce the requirement for corticosteroids. Besides, sirolimus is effective for treatment of de novo autoimmune hepatitis that sometimes develops after liver transplantation. Initial experience with the sirolimus analog everolimus in non-grafted patients with severe AIH complicated by renal dysfunction seems promising. As the experience with these newer therapeutic agents have only been studied in small numbers of patients, larger and controlled clinical trials are clearly needed to ensure that such therapeutic possibilities are expanding without overlook serious side effects.