Histological features associated with relapse after corticosteroid withdrawal in type 1 autoimmune hepatitis.
Relapse of type 1 autoimmune hepatitis after drug withdrawal may relate to incomplete histological improvement during corticosteroid therapy and/or persistence of pathogenic mechanisms.


OBJECTIVE
Determine the histological features prior to drug withdrawal that are associated with relapse in patients satisfying pre-established clinical, laboratory, and histological criteria for remission and relapsing after corticosteroid withdrawal.


METHODS
One hundred liver tissue samples obtained immediately prior to corticosteroid withdrawal from 88 patients who had previously satisfied criteria for histological remission were reviewed retrospectively.


RESULTS
Histological findings in the patients who relapsed were similar to those in the patients who sustained remission in regard to histological activity index (1.7 +/- 0.1 versus 1.6 +/- 0.2, P = 0.6), fibrosis score (2.6 +/- 0.3 versus 2.3 +/- 0.4, P = 0.5), and frequencies of interface hepatitis (36% versus 20%, P = 0.2), cirrhosis (21% versus 17%, P = 0.8), and normal or near normal tissue (9% versus 7%, P > 0.9). Only the presence of portal plasma cells was associated with relapse (31% versus 7%, P = 0.01). The positive predictability of portal plasma cell infiltration for relapse was 92%, but its sensitivity was only 31%.


CONCLUSIONS
Portal plasma cell infiltration is predictive of relapse after drug withdrawal in tissue specimens already satisfying criteria for remission. Portal plasma cell infiltration may be indicative of an active antibody-dependent pathogenic mechanism. Its low sensitivity for relapse indicates the need for other complementary predictors of outcome.
Czaja
Albert J
AJ
Division of Gastroenterology and Hepatology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA. czaja.albert@mayo.edu
Carpenter
Herschel A
HA
D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D019693:Hepatitis, Autoimmune / Q000188:drug therapy* / Q000473:pathology / Q000523:psychology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008099:Liver / Q000166:cytology / Q000187:drug effects / Q000473:pathology; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D017060:Patient Satisfaction; D011237:Predictive Value of Tests; D011241:Prednisone / Q000627:therapeutic use; D012008:Recurrence; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013375:Substance Withdrawal Syndrome; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D001379:Azathioprine; D011241:Prednisone