REVERSIBILITY OF HEPATIC-FIBROSIS IN AUTOIMMUNE HEPATITIS

Background: Hepatic fibrosis and cirrhosis occur in many types of chro nic liver injury and generally seem to be irreversible. Objective: To determine whether cirrhosis caused by autoimmune hepatitis can be reve rsible. Design: Retrospective study. Patients: Eight patients with aut oimmune hepatitis and cirrhosis who responded to medical therapy and h ad follow-up liver biopsy while in clinical and biochemical remission. Measurements: Biopsy specimens were randomly coded in an unpaired man ner according to patient and were read independently by two pathologis ts using the Knodell scoring system. Results: The median alanine amino transferase level decreased from 10.30 mu kat/L to 0.37 mu kat/L, the median serum bilirubin level decreased from 70 mu mol/L to 10 mu mol/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 scor e decreased from 3.3 to 0.8. Conclusion: Hepatic fibrosis and cirrhosi s may be reversible in some patients in whom autoimmune hepatitis resp onds to treatment.