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Autoimmune Hepatitis

Unlike other forms of hepatitis, such as viral and toxic hepatitis, autoimmune hepatitis occurs when the body's immune system mistakenly attacks healthy liver cells. As a result, the liver becomes inflamed and hepatitis develops. In severe cases or if left untreated, the condition can lead to scarring of the liver, a condition known as cirrhosis, and ultimately to liver failure.

Research has shown that genetic factors may increase some people's risk of developing autoimmune hepatitis. While people of any age can develop autoimmune hepatitis, women between the ages of 20 to 40 are most commonly affected.

If the condition progresses, resulting in severe liver damage or liver failure, a liver transplant may be necessary. The UCSF Liver Transplant Program, which integrates the efforts of gastroenterologists and surgeons, performs over 100 transplants each year, making it one of the leading programs in the U.S. Survival statistics are among the very best in the country.

Symptoms of autoimmune hepatitis vary, depending on the severity. However, some of the more common include:

  • Fatigue
  • Enlarged liver
  • Jaundice, a condition that causes a yellowing tint of the skin and eyes
  • Joint pain
  • Abdominal discomfort
  • Blood vessels that appear as "spiders" on the surface of the skin
  • Nausea
  • Vomiting
  • Loss of appetite
  • Dark urine
  • Mental confusion, which may occur in advanced stages

In making a diagnosis of autoimmune hepatitis, your doctor will start by conducting a thorough physical examination and asking about your medical history, including any symptoms you have been experiencing.

You may also receive the following tests:

  • Blood Tests — A series of blood tests will be conducted to detect any antibodies that indicate autoimmune hepatitis and liver injury. In addition, blood tests help to distinguish which type of hepatitis you have.
  • Liver Biopsy — Because diseases other than autoimmune hepatitis can give rise to these antibodies, a liver biopsy often is done to establish the diagnosis. During a biopsy, a small sample of tissue is removed from your liver using a thin needle. The tissue is prepared and stained in a laboratory for examination under a microscope.

A drug called prednisone is the cornerstone of treatment for autoimmune hepatitis. It is initially given in high doses, which are tapered when the liver begins to respond.

The optimal length of prednisone treatment is uncertain. Because many patients relapse after relatively brief treatment, most doctors recommend prednisone at the lowest effective dose for one to two years before stopping. The long-term outlook depends on the success of the patient's initial treatment.

For patients who are resistant to prednisone, other types of immunosuppression may be tried. Liver transplantation is the treatment for cases that progress to liver failure.

Liver Transplantation

Liver transplant is recommended for people whose autoimmune hepatitis causes severe liver damage or progresses to liver failure. The evaluation for a transplant is complex and generally requires several months. Therefore, even if a patient is feeling well, they should be referred for a transplant at the first sign of liver failure or if they have advanced liver disease diagnosed by X-ray studies or liver biopsy.

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Reviewed by health care specialists at UCSF Medical Center.

Related Information

UCSF Clinics & Centers

Gastroenterology

Liver Disease and Liver Transplant
350 Parnassus Ave., Suite 300
San Francisco, CA 94143
Phone: (415) 353-2318
Fax: (415) 353-2407
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Liver Transplant Program
400 Parnassus Ave., Sixth Floor
San Francisco, CA 94143
Phone: (415) 353-1888
Fax: (415) 353-8917
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