Alimentary pharmacology & therapeutics · 2026
Review article: Immunosuppression in Decompensated Autoimmune Hepatitis Cirrhosis - To Suppress or Not to Suppress?
СтатьяОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Passos Pedro Robson Costa, Filho Valbert Oliveira Costa, Cançado Guilherme Grossi Lopes
Аннотация
BACKGROUND: The management of decompensated autoimmune hepatitis (AIH) cirrhosis is one of the most challenging and controversial scenarios in hepatology. Clinicians face a high-stakes dilemma: whether to initiate immunosuppression to halt inflammatory activity or prioritize liver transplantation (LT) referral to avoid treatment futility and life-threatening infections.
AIMS: To critically appraise the evidence regarding immunosuppression in decompensated AIH cirrhosis and propose a biologically grounded, risk-stratified framework for clinical decision-making.
METHODS: This review synthesizes current observational data and retrospective studies, focusing on patient selection, the 'therapeutic window' for medical intervention and the physiological impact of cirrhosis-associated immune dysfunction.
RESULTS: The risks of infection, treatment futility and delayed transplant access must be weighed against the possibility of halting inflammatory activity and achieving clinical stabilization. A narrow therapeutic window exists for medical therapy. Clinical 'recompensation' is achievable in 19%-31% of cases, though this is less frequent than in other etiologies. Early dynamic response assessment-specifically changes in bilirubin and MELD-Na at weeks 1 and 4-helps distinguish responders from those requiring urgent LT. While LT offers excellent long-term survival, recurrence occurs in 20% of cases.
CONCLUSIONS: Management must shift from a 'one-size-fits-all' approach to an individualized, protocolized strategy. We advocate for a time-limited trial of immunosuppression in selected candidates, governed by strict 'stop rules' and immediate LT evaluation for non-responders or high-risk patients.
AIMS: To critically appraise the evidence regarding immunosuppression in decompensated AIH cirrhosis and propose a biologically grounded, risk-stratified framework for clinical decision-making.
METHODS: This review synthesizes current observational data and retrospective studies, focusing on patient selection, the 'therapeutic window' for medical intervention and the physiological impact of cirrhosis-associated immune dysfunction.
RESULTS: The risks of infection, treatment futility and delayed transplant access must be weighed against the possibility of halting inflammatory activity and achieving clinical stabilization. A narrow therapeutic window exists for medical therapy. Clinical 'recompensation' is achievable in 19%-31% of cases, though this is less frequent than in other etiologies. Early dynamic response assessment-specifically changes in bilirubin and MELD-Na at weeks 1 and 4-helps distinguish responders from those requiring urgent LT. While LT offers excellent long-term survival, recurrence occurs in 20% of cases.
CONCLUSIONS: Management must shift from a 'one-size-fits-all' approach to an individualized, protocolized strategy. We advocate for a time-limited trial of immunosuppression in selected candidates, governed by strict 'stop rules' and immediate LT evaluation for non-responders or high-risk patients.