title: Management of Difficult Cases of Autoimmune Hepatitis.
abstract: Autoimmune hepatitis (AIH) is a complex autoimmune disease characterized by immune-mediated destruction of hepatic parenchyma which can result in cirrhosis, liver failure, and death. Current American Association for the Study of Liver Diseases (AASLD) and European Association for the Study of Liver (EASL) guidelines recommend corticosteroids alone or in combination with azathioprine as first-line treatment strategies. However, a significant proportion of patients may not be able to tolerate or achieve complete biochemical response with these options. In this article, we discuss approaches to these patients and other challenging AIH patient groups such as the asymptomatic, pregnant, elderly, and liver transplant recipients.
authors.affiliation: Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, 46202, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Lammert
authors.affiliation: Division of Hepatology, Loyola University, Maywood, IL, USA.
authors.forename: Veronica M
authors.initials: VM
authors.lastname: Loy
authors.affiliation: Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Kiyoko
authors.initials: K
authors.lastname: Oshima
authors.affiliation: Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, 46202, USA. sgawrieh@iu.edu.
authors.forename: Samer
authors.initials: S
authors.lastname: Gawrieh
mesh_terms: D000208:Acute Disease; D001379:Azathioprine / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D019693:Hepatitis, Autoimmune / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D017211:Treatment Failure
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D001379:Azathioprine
keywords: Autoimmune hepatitis; Cirrhosis; Liver transplantation; Nonstandard treatment; Pregnancy; Refractory