Albert J Czaja1, Herschel A Carpenter. 1. Division of Gastroenterology and Hepatology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA. czaja.albert@mayo.edu
Abstract
UNLABELLED: Relapse of type 1 autoimmune hepatitis after drug withdrawal may relate to incomplete histological improvement during corticosteroid therapy and/or persistence of pathogenic mechanisms. AIM: Determine the histological features prior to drug withdrawal that are associated with relapse in patients satisfying pre-established clinical, laboratory, and histological criteria for remission and relapsing after corticosteroid withdrawal. METHODS: One hundred liver tissue samples obtained immediately prior to corticosteroid withdrawal from 88 patients who had previously satisfied criteria for histological remission were reviewed retrospectively. RESULTS: Histological findings in the patients who relapsed were similar to those in the patients who sustained remission in regard to histological activity index (1.7 +/- 0.1 versus 1.6 +/- 0.2, P = 0.6), fibrosis score (2.6 +/- 0.3 versus 2.3 +/- 0.4, P = 0.5), and frequencies of interface hepatitis (36% versus 20%, P = 0.2), cirrhosis (21% versus 17%, P = 0.8), and normal or near normal tissue (9% versus 7%, P > 0.9). Only the presence of portal plasma cells was associated with relapse (31% versus 7%, P = 0.01). The positive predictability of portal plasma cell infiltration for relapse was 92%, but its sensitivity was only 31%. CONCLUSIONS: Portal plasma cell infiltration is predictive of relapse after drug withdrawal in tissue specimens already satisfying criteria for remission. Portal plasma cell infiltration may be indicative of an active antibody-dependent pathogenic mechanism. Its low sensitivity for relapse indicates the need for other complementary predictors of outcome.
UNLABELLED: Relapse of type 1 autoimmune hepatitis after drug withdrawal may relate to incomplete histological improvement during corticosteroid therapy and/or persistence of pathogenic mechanisms. AIM: Determine the histological features prior to drug withdrawal that are associated with relapse in patients satisfying pre-established clinical, laboratory, and histological criteria for remission and relapsing after corticosteroid withdrawal. METHODS: One hundred liver tissue samples obtained immediately prior to corticosteroid withdrawal from 88 patients who had previously satisfied criteria for histological remission were reviewed retrospectively. RESULTS: Histological findings in the patients who relapsed were similar to those in the patients who sustained remission in regard to histological activity index (1.7 +/- 0.1 versus 1.6 +/- 0.2, P = 0.6), fibrosis score (2.6 +/- 0.3 versus 2.3 +/- 0.4, P = 0.5), and frequencies of interface hepatitis (36% versus 20%, P = 0.2), cirrhosis (21% versus 17%, P = 0.8), and normal or near normal tissue (9% versus 7%, P > 0.9). Only the presence of portal plasma cells was associated with relapse (31% versus 7%, P = 0.01). The positive predictability of portal plasma cell infiltration for relapse was 92%, but its sensitivity was only 31%. CONCLUSIONS: Portal plasma cell infiltration is predictive of relapse after drug withdrawal in tissue specimens already satisfying criteria for remission. Portal plasma cell infiltration may be indicative of an active antibody-dependent pathogenic mechanism. Its low sensitivity for relapse indicates the need for other complementary predictors of outcome.