Probabilities of clinical, biochemical, and histologic remission during corticosteroid therapy.

Clinical features of type 2 autoimmune hepatitis.

•The diagnosis requires the presence of antibodies to liver–kidney microsome type 1 (Anti-LKM1). But antibodies to hepatitis C virus and hepatitis C virus RNA may be present

•The disease has been described mainly in pediatric patients in Western Europe, but adults may also be afflicted. In the United States, seropositivity for Anti-LKM1 has been found in only 4% of adults and hepatitis C virus infection has not been a feature of the disease.

•Patients with type 2 autoimmune hepatitis typically have concurrent immunologic diseases, including autoimmune thyroiditis, insulin- dependent diabetes, vitiligo, and ulcerative colitis

•They have a high frequency of organ-specific autoantibodies, such as parietal cell antibodies, antibodies to the islets of Langerhans, and thyroid antibodies .

•An acute, even fulminant, presentation may occur, and patients uncommonly have a pronounced hypergammaglobulinemia

Liver transplantation for autoimmune hepatitis.

•Decompensated patients should be considered for liver transplantation.

•The 5-year survival rate after transplantation is 92%.

•Recurrence of disease is rare but possible in inadequately immunosuppressed recipients and in HLA-DR3–positive recipients of HLA- DR3–negative grafts

Survival expectations and probability of developing cirrhosis during and after corticosteroid treatment.

•Patients without cirrhosis at presentation have better 5- and 10-year survival rates than patients with cirrhosis at presentation

•Cirrhosis develops in 47% of patients within 10 years after presentation despite corticosteroid treatment

•The highest probability of cirrhosis is during initial therapy when the disease is most active. The mean annual incidence of cirrhosis after initial remission is 2.6%

•Survival after the development of cirrhosis during or after treatment is similar to that of patients without cirrhosis

liver biopsy

•Percutaneous liver biopsy with or without ultrasonic guidance is a standard diagnostic approach for establishing the presence of chronic hepatitis. Laparoscopic liver biopsy, which is used in large referral centers, has the advantage of minimizing the sample error by facilitating gross inspection of the liver and thus ensuring an adequate biopsy sample size. This figure depicts a laparoscopic view of a patient with chronic active hepatitis and early cirrhosis [20] [21]. (Courtesy of David Bernstein and Eugene R. Schiff.)