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World J Gastroenterol. Apr 28, 2011; 17(16): 2070-2075
Published online Apr 28, 2011. doi: 10.3748/wjg.v17.i16.2070
Optimizing management in autoimmune hepatitis with liver failure at initial presentation
Jonathan R Potts, Sumita Verma
Jonathan R Potts, Sumita Verma, Department of Medicine, Brighton and Sussex Medical School, Brighton, BN1 9PX, United Kingdom
Author contributions: Verma S conceived the idea; Potts JR performed the literature search; Verma S wrote the initial draft; Potts JR and Verma S contributed equally to writing the final draft of the manuscript.
Correspondence to: Dr. Sumita Verma, Senior Lecturer Medicine, Honorary Consultant Hepatologist, Department of medcine Brighton and Sussex Medical School, Falmer, Department of medcine Brighton, BN1 9PX, United Kingdom. s.verma@bsms.ac.uk
Telephone: +44-1273-877890 Fax: +44-1273-877576
Received: October 12, 2010
Revised: November 4, 2010
Accepted: November 11, 2010
Published online: April 28, 2011

Autoimmune hepatitis (AIH) is a disease of unknown etiology, its hallmark being ongoing hepatic inflammation. By its very nature, it is a chronic condition, although increasingly, we are becoming aware of patients with acute presentations, some of whom may have liver failure. There are very limited published data on patients with AIH with liver failure at initial diagnosis, which consist mostly of small retrospective studies. As a consequence, the clinical features and optimal management of this cohort remain poorly defined. A subset of patients with AIH who present with liver failure do respond to corticosteroids, but for the vast majority, an urgent liver transplantation may offer the only hope of long-term survival. At present, there is uncertainty on how best to stratify such a cohort into responders and non- responders to corticosteroids as soon as possible after hospitalization, thus optimizing their management. This editorial attempts to answer some of the unresolved issues relating to management of patients with AIH with liver failure at initial presentation. However, it must be emphasized that, at present, this editorial is based mostly on small retrospective studies, and it is an understatement that multicenter prospective studies are urgently needed to address this important clinical issue.

Keywords: Autoimmune hepatitis, Liver failure, Liver transplantation, Corticosteroids