Reversibility of Hepatic Fibrosis in Autoimmune Hepatitis

BACKGROUND: Hepatic fibrosis and cirrhosis occur in many types of chronic liver injury and generally seem to be irreversible. OBJECTIVE: To determine whether cirrhosis caused by autoimmune hepatitis can be reversible. DESIGN: Retrospective study. PATIENTS: Eight patients with autoimmune hepatitis and cirrhosis who responded to medical therapy and had follow-up liver biopsy while in clinical and biochemical remission. MEASUREMENTS: Biopsy specimens were randomly coded in an unpaired manner according to patient and were read independently by two pathologists using the Knodell scoring system. RESULTS: The median alanine aminotransferase level decreased from 10.30 mukat/L to 0.37 mukat/L, the median serum bilirubin level decreased from 70 mumol/L to 10 mumol/L, and the median serum albumin level increased from 34 g/L to 43 g/L. Cirrhosis, extensive fibrosis, or both were present in all patients at diagnosis but were not present on follow-up liver biopsy. The median Knodell score decreased from 14.0 to 1.3, and the median fibrosis score decreased from 3.3 to 0.8. CONCLUSION: Hepatic fibrosis and cirrhosis may be reversible in some patients in whom autoimmune hepatitis responds to treatment.