Autoimmune liver disease.
Autoimmune hepatitis is as virulent in the elderly as in the young, and initial treatment should be similar. Antiphospholipid antibodies should be sought in all patients with a history of fetal loss or arterial or venous thrombosis. The C282Y mutation in the HFE hemochromatosis gene occurs more commonly in autoimmune hepatitis than in normal subjects, but it is not associated with distinctive features. Children with autoimmune hepatitis may have abnormal cholangiogram results, but the syndrome of autoimmune sclerosing cholangitis does not affect immediate prognosis. Bile duct changes, including destructive cholangitis, can be incidental findings that have no clinical expression or therapeutic consequence. In South America, DRB1*1301 is associated with protracted hepatitis A virus infection which may enhance exposure to hepatic self-antigens in children. Interferon gamma-inducible protein 10 may be an important chemokine that promotes liver damage by attracting activated T cells. Transcripts of Fas ligand are abnormally increased in autoimmune hepatitis, and apoptotic dysfunction may contribute to disease progression. Pregnancy is not contraindicated in autoimmune hepatitis, and cyclosporine may be effective as first-line therapy.
Czaja
Albert J
AJ
Division of Gastroenterology and Hepatology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA. czaja.albert@mayo.edu