Autoimmune hepatitis

• Autoimmune disease resulting in antibodies directed against hepatocyte surface antigens
• There are two types;
  • Type I
    • Affects children and adults (bimodal distribution)
    • Anti-smooth muscle antibodies in 80%
    • ANA positive in 10%
  • Type II
    • Affects children
    • More commonly progresses to cirrhosis
    • Associated with anti-liver/kidney microsomal type I antibodies

• Associated with;
  • Pernicious anaemia
  • Autoimmune haemolysis
  • UC
    DM
  • Autoimmune thyroiditis

Clinical features

• Predominantly affects young/middle aged women
• 25% present with acute hepatitis and features of autoimmune disease – fever, malaise, rash, polyarthritis,
• The remainder present insidiously
• Complications are those associated with cirrhosis

Tests

• Abnormal LFTs – raised AST
• Hypergammaglobulinaemina (IgG)
• Positive autoantibodies – ANA, SMA, anti-liver/kidney microsomal antibodies
• Anaemia, reduced WCC and platelets indicated hypersplenism

Management

• Prednisolone
• Azathioprine
• Liver transplantation

Prognosis

• Overall 80% over ten years, reduced if there is cirrhosis