Effect of treatment of hepatic histopathology in children and adolescents with autoimmune hepatitis.
OBJECTIVE
To evaluate the effects of treatment on liver histopathology of children and adolescents diagnosed with autoimmune hepatitis.


METHODS
Histopathological evaluation of liver biopsies performed at diagnosis or early during treatment, compared with biopsies after immunosuppressive treatment of 20 children and adolescents diagnosed with autoimmune hepatitis who presented clinical and biochemical remission for at least 24 months. Liver histopathology was assessed by 2 pathologists. Agreement between their interpretations was analyzed with kappa statistics.


RESULTS
The age at diagnosis of the 20 patients varied from 1.7 years to 11.6 years (median = 6.6 years); 18 were females. The mean duration of clinical and biochemical remission, up to performance of liver biopsy, was 4.1 years. The mean interval between the initial and posttreatment biopsies was 4.6 years (range 2-9.7 years). Assessing the necroinflammatory activity, a mean reduction by 6.3 (observer 1) and 7.3 (observer 2) in the grading score was observed (P = 0.00000). When staging was assessed, a mean reduction by 1.8 (observers 1 and 2) in the score was observed after treatment (P = 0.00008), and there was no progression toward cirrhosis. No regression of cirrhosis was observed.


CONCLUSIONS
On histopathological evaluation, the immunosuppressive treatment improved the fibrosis scores, with an arrest in its progression and no development into cirrhosis. Fibrosis control is mainly associated with regression of necroinflammatory activity, which is the main treatment component in autoimmune hepatitis.
Ferreira
Alexandre Rodrigues
AR
Department of Pediatrics, Universidade Federal de Minas Gerais Medical School, Belo Horizonte, Brazil. alexfer@uai.com.br
Roquete
Mariza Leitão Valadares
ML
Toppa
Nivaldo H
NH
de Castro
Lúcia Porto Fonseca
LP
Fagundes
Eleonora Druve Tavares
ED
Penna
Francisco José
FJ
D001707:Biopsy, Needle; D002648:Child; D002675:Child, Preschool; D005260:Female; D019693:Hepatitis, Autoimmune / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000473:pathology; D008297:Male
D007166:Immunosuppressive Agents