Current status of autoimmune hepatitis in Japan

Acta Med Okayama. 2008 Aug;62(4):217-26. doi: 10.18926/AMO/30943.

Abstract

Autoimmune hepatitis (AIH) is a chronic and progressive disease characterized by histological interface hepatitis, hypergammaglobulinemia, and circulating autoantibodies. Multiple factors, including molecular mimicry, a genetic background including major histocompatibility complex class II, and defective function of regulatory T-cells, are involved in the pathogenesis. The diagnosis is made based on the scoring system of the International Autoimmune Hepatitis Group, the sensitivity and specificity of which are > 90%, respectively. AIH is classified into 3 sub-types based on the profiles of circulating autoantibodies: anti-nuclear antibody and/or smooth muscle antibody-positive (type 1), anti-liver-kidney microsomal antibody-positive (type 2), and anti-soluble liver antigen/liver-pancreas antigen antibody- positive (type 3). Recently, however, the number of atypical cases lacking the usual features has increased--for example, patients with acute-onset or fulminant-type AIH, autoantibody-negative patients, male patients, and patients with bile duct injury--and thus the clinical features of AIH have been diversified. AIH is responsive to immunosuppressive treatment in most cases; however, relapse occurs in more than 80% of patients within 1 year after immunosuppressive treatment withdrawal. The 10-year survival rate and the 10-year hepatocellular carcinoma-free rate are > 90%, respectively, indicating that some patients reach liver failure or develop hepatocellular carcinoma. To improve the prognosis of these patients, persistent normalization of transaminase is required.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Azathioprine / therapeutic use
  • Hepatitis, Autoimmune / diagnosis*
  • Hepatitis, Autoimmune / immunology
  • Hepatitis, Autoimmune / physiopathology*
  • Hepatitis, Autoimmune / therapy
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Japan
  • Liver Transplantation
  • Prognosis

Substances

  • Adrenal Cortex Hormones
  • Immunosuppressive Agents
  • Azathioprine