Original article—liver, pancreas, and biliary tract
Patients With Typical Laboratory Features of Autoimmune Hepatitis Rarely Need a Liver Biopsy for Diagnosis

https://doi.org/10.1016/j.cgh.2010.07.016Get rights and content

Background & Aims

The importance of histologic analysis of biopsy samples in the diagnosis and management of patients with autoimmune hepatitis (AIH) is unclear.

Methods

Patients with AIH were identified from a 10-year database. Individuals with overlap syndromes and decompensated liver disease were excluded. The proportion of patients who fulfilled the new simplified criteria for AIH was calculated.

Results

A total of 257 patients (203 female) with a median age of 52 years (interquartile range, 39–63 y) were diagnosed with AIH. Overall, 183 of 257 (71%) were positive for antinuclear antibodies, 116 (45%) had positive smooth muscle antibodies, and 29 of 257 (11%) were seronegative. A total of 250 (97%) patients had increased levels of autoantibodies and/or γ-globulins. In 95% (243 of 257 cases), the histology was compatible with AIH whereas 5% (14 cases) had atypical histology. Overall, 77% had a score of at least 6, indicating probable or definite AIH according to most recent criteria; 22% were diagnosed with AIH with less than 6 points and 1 patient had nonalcoholic steatohepatitis based on biopsy analysis. Immunosuppression occurred in 93% of patients. Patients with atypical versus compatible histology were similar in terms of seronegativity or γ-globulins; 86% (12 of 14) received immunosuppressive therapy despite atypical histology.

Conclusions

Most patients with features of AIH, based on laboratory analyses, are likely to have a compatible liver histology. Few patients have atypical histology and these findings have little impact on patient management. These findings indicate biopsy samples might not need to be collected from patients who meet other clinical criteria for AIH.

Section snippets

Patients and Methods

A search was performed in the diagnoses medical index at the Mayo Clinic (Rochester, MN) for AIH from 1997 to 2007. The search was based on the presence of AIH in the text and the search retrieved all patients who had AIH mentioned in the medical charts, such as the primary diagnosis, differential diagnosis, family history of AIH, and liver transplantation for AIH. We identified 1532 patients. Only patients with available clinical and biochemical components of the new simplified criteria at

General Characteristics of the Patients

A total of 257 well-characterized AIH patients were identified with available clinical, laboratory, and histologic data required for diagnosis according to the new simplified criteria. Overall, 560 patients were excluded owing to an earlier diagnosis of AIH outside the Mayo Clinic and already were started on treatment when first seen at the Mayo Clinic. There were 125 who had decompensated liver disease at presentation or had undergone transplantation for AIH (n = 70). There were 57 patients

Discussion

Our study indicates that the vast majority of patients with typical laboratory features of AIH are likely to have compatible liver histology. Among patients with a clinical diagnosis of AIH, very few have atypical histology yet the presence of atypical histology may have very little impact on patient management. Posttreatment liver biopsy does not seem to impact clinical decision making. Furthermore, the presence of mild interface hepatitis did not predict a relapse.

As pointed out in a recent

Cited by (47)

  • Infliximab-induced liver injury: Clinical phenotypes, autoimmunity and the role of corticosteroid treatment

    2022, Journal of Hepatology
    Citation Excerpt :

    The role of liver biopsies is also not entirely certain in AIH. Biopsies are often used in the diagnosis of AIH but most patients with clinical and laboratory features of AIH were found to have a compatible liver histology, and clinical management was not changed due to atypical histology as most patients were treated with immunosuppressive agents.25 HLA genotypes have been suggested as potential biomarkers to aid in the clinical diagnosis of DILI.

  • Diagnosis and Treatment of Autoimmune Liver Diseases in a Tertiary Referral Center in Cuba

    2017, Current Therapeutic Research - Clinical and Experimental
    Citation Excerpt :

    Interface hepatitis was previously reported in 65% of patients, including patients with overlap AIH-PBC.19 Choudhuri et al17 found this in 72.7%, Bjornsson et al32 in 95%, and Gupta et al18 and Abdollahi et al33 found this in 100% of patients. Furthermore, lymphoplasmacytic infiltrate of portal tracts has been reported between 60% and 91% of patients.

  • The utility of repeat liver biopsy in autoimmune hepatitis: a series of 20 consecutive cases

    2016, Pathology
    Citation Excerpt :

    Several publications have challenged the significance of performing liver biopsy in AIH patients. A retrospective study evaluating 257 AIH patients reported that the vast majority of patients with typical laboratory features of AIH were likely to have compatible histological findings in the biopsy and a few cases with atypical histological findings did not have a significant impact on patient management.6 Another study of 82 AIH patients showed that normalisation of serum parameters [alanine aminotransferase (ALT) and IgG] was associated with patients who were at low risk of fibrosis progression despite the fact that laboratory indices were not reliable to predict complete histological remission.7

  • Autoimmune Hepatitis and Overlap Syndromes: Diagnosis and Management

    2015, Clinical Gastroenterology and Hepatology
    Citation Excerpt :

    Central zonal necrosis and/or perivenulitis of the central veins (Figure 2) is another feature of acute and chronic AIH and may occur in the absence of interface hepatitis.48,49 The need for a liver biopsy to diagnose AIH has been challenged.50 However, SDC scores were probable in 77% and nondiagnostic in 22% diagnosed without liver biopsy.

View all citing articles on Scopus

Conflicts of interest The authors disclose no conflicts.

Funding Professor Einar Björnsson received financial support from the Swedish Medical Research Council during his stay at the Mayo Clinic from 2008 to 2009.

View full text