ArticleJHEP reports : innovation in hepatology2021
Histological activity despite normal ALT and IgG serum levels in patients with autoimmune hepatitis and cirrhosis.
Article in JHEP reports : innovation in hepatology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 3 of them syntheses that pooled it.
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Who cites it
25 citing papers in PubMed, 3 syntheses or guidelines pooled it, 41 citations in OpenAlex.
- Autoimmune hepatitis in children: Guidelines of the Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ISPGHAN).Hepatology international · 2025Guideline
- British Society of Gastroenterology guidelines for diagnosis and management of autoimmune hepatitis.Gut · 2025Guideline
- KASL clinical practice guidelines for management of autoimmune hepatitis 2022.Clinical and molecular hepatology · 2023Guideline
- Short term synbiotic supplementation improves hepatic and metabolic outcomes in children with metabolic dysfunction associated steatotic liver disease.Scientific reports · 2026Trial
- Review article: Immunosuppression in Decompensated Autoimmune Hepatitis Cirrhosis - To Suppress or Not to Suppress?Alimentary pharmacology & therapeutics · 2026Review
- Article
- Diagnostic Impact of Liver Biopsy Among Antinuclear Antibody Positive Individuals With Mild Liver Enzyme Elevation.Alimentary pharmacology & therapeutics · 2026Article
- Reply to: "Extending the Baveno VII definition of recompensation to autoimmune hepatitis: Considerations regarding treatment timing and response criteria".JHEP reports : innovation in hepatology · 2026Article
- Extending the Baveno VII definition of recompensation to autoimmune hepatitis: Considerations regarding treatment timing and response criteria.JHEP reports : innovation in hepatology · 2026Article
- Isolated IgG elevation in patients with persistently normal transaminases does not affect the outcome of autoimmune hepatitis.JHEP reports : innovation in hepatology · 2025Article
- Recompensation in patients with autoimmune hepatitis-related decompensated cirrhosis following immunosuppressive therapy.JHEP reports : innovation in hepatology · 2025Article
- Real-World Assessment of Liver Corrected T1 and Magnetic Resonance Elastography in Predicting Liver Disease Progression.Liver international : official journal of the International Association for the Study of the Liver · 2025Article
- Diagnostic performance of FibroTest-ActiTest, transient elastography, and the fibrosis-4 index in patients with autoimmune hepatitis using histological reference.World journal of hepatology · 2025Article
- Autoimmune hepatitis: clinicopathological characteristics and histopathological diagnosis in the light of current views.Clinical and experimental hepatology · 2025Review
- Review
- Liver stiffness measurement predicts clinical outcomes in autoimmune hepatitis.JHEP reports : innovation in hepatology · 2024Article
- Liver inflammation activity in patients with autoimmune hepatitis with normal alanine aminotransferase and immunoglobulin G levels.Journal of translational autoimmunity · 2024Article
- Hepatic and Extrahepatic Characteristics of Autoimmune Hepatitis: A 23-year Hospital-Based Cohort Study.Digestive diseases and sciences · 2024Article
- Article
- Accuracy of controlled attenuation parameter measurement for the detection of steatosis in autoimmune liver diseases.JHEP reports : innovation in hepatology · 2023Article
Corrections and comments
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Authors and funding
19 authors at 6 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND &
aimsIn autoimmune hepatitis (AIH), normal levels of transaminases and IgG define biochemical remission and are considered the best surrogate markers for histological remission. This study assessed whether this also applies to patients with AIH cirrhosis.
methodsIn this European multicentric study, we included 125 biopsies from 113 patients with AIH and histologically proven cirrhosis; 105 biopsies from 104 patients with AIH without cirrhosis served as controls. Biochemical parameters were available within 4 weeks of biopsy. AIH activity was graded according to the modified Hepatitis Activity Index (mHAI), with mHAI ≥4/18 considered to indicate risk of disease progression.
resultsIn total, 47 out of 125 liver biopsies were obtained from patients with AIH cirrhosis and normal ALT levels at time of biopsy. Only 26% (12/47) of those livers showed histological remission (mHAI <4/18), whereas 36% (17/47) showed moderate to high histological activity (mHAI ≥6/18). In patients with noncirrhotic AIH, 88% (46/52 biopsies) of cases with normal ALT levels had histological remission and only 4% (2/52) had an mHAI ≥6/18 (
conclusionsIn contrast to patients with noncirrhotic AIH, in patients with AIH cirrhosis, who are at risk of disease progression, normal ALT levels and potentially also complete biochemical remission are poor surrogate markers of histological remission. Thus, new biomarkers are needed to monitor disease activity and progression in patients with AIH cirrhosis. LAY SUMMARY: Autoimmune hepatitis (AIH) is an inflammatory disease of the liver that usually responds to immunosuppressive therapy. Serum transaminases and IgG levels within the normal ranges define complete biochemical remission and are considered as surrogate markers for histological disease activity. Here, we show that those biochemical markers are not sufficient to indicate low disease activity in patients with AIH and already established cirrhosis. Consequently, until better biomarkers for disease activity are found, only liver biopsy can reliably indicate disease activity in the presence of cirrhosis. Additional investigations, such as measurements of liver stiffness, should be undertaken to monitor non-invasively for disease progression in patients with AIH and established cirrhosis.
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