Effect of treatment of hepatic histopathology in children and adolescents with autoimmune hepatitis

AR Ferreira, MLV Roquete, NH Toppa… - Journal of pediatric …, 2008 - journals.lww.com
AR Ferreira, MLV Roquete, NH Toppa, LPF de Castro, EDT Fagundes, FJ Penna
Journal of pediatric gastroenterology and nutrition, 2008journals.lww.com
Objective: To evaluate the effects of treatment on liver histopathology of children and
adolescents diagnosed with autoimmune hepatitis. Patients and 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 …
Abstract
Objective:
To evaluate the effects of treatment on liver histopathology of children and adolescents diagnosed with autoimmune hepatitis.
Patients and 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 κ 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.
Lippincott Williams & Wilkins