Reversibility of hepatic fibrosis in autoimmune hepatitis.

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 mukat/L to 0.37 mukat/L, the median serum bilirubin level decreased from 70 mumol/L to 10 mumol/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.