Impact of the combined low dose prednisolone regimen on liver fibrosis in children with autoimmune hepatitis who responded to treatment

ABSTRACT

Autoimmune hepatitis [AIH] is a chronic liver disease characterized histologically by interface hepatitis. Hepatic fibrosis and cirrhosis can occur in many types of chronic liver injury including AIH. Recent studies have reported that hepatic fibrosis and cirrhosis may be reversible in some patients with AIH who respond to treatment. To assess the effects of treatment on fibrosis in liver biopsies of children with AIH who responded to the combined low dose prednisolone and azathioprine regimen. Twenty children with median age 8 +/- 3.5 yrs [9 girls, 11 boys], 18 AIH type I and two AIH type II, who were in clinical and biochemical remission for at least 6 months, and who had a diagnostic and a follow-up liver biopsy were included in this study. Different histological stains were used for assessing the grade of necroinflammatory activity [HAI] and for evaluating the stage of fibrosis according to Ishak scoring system. Morphometric analysis using LeicaQ500IS image analyzer was applied on Peri's stained liver sections to assess the percentage of liver fibrosis. Data revealed significant decrease in the median HAI from 8.85 to 3.6 [p=0.001]. The median fibrosis score showed significant reduction from 3.9 to 2.4 [p=0.001] and the median fibrosis percentage decreased from 28.7 to 12.8 [p=0.001]. These data provide evidence for regression of fibrosis in AIH in children who responded to the combined low dose immunosuppressive prednisolone and azothioprine regimen. Fibrosis control is associated with regression of necroinflammatory activity, which is the main treatment component in AIH