Abstract

Autoimmune hepatitis (AIH) is a chronic liver disease characterised histologically by interface hepatitis, portal plasma lymphocytic infiltrates and parenchymal inflammation. 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. Therefore the objectives of this study were to compare between liver histolopathology of children with AIH at initial diagnosis and at follow-up management biopsies regarding necroinflammatory activity, fibrosis score and fibrosis percentage. Sixteen children with a median age of 8 ± 3.5 years (10 girls, six boys), 15 were AIH type I whereas one girl was AIH type II, who presented clinical and biochemical remission for at least 6 months and had a follow-up liver biopsy were included in this study. The grade of necroinflammatory activity (HAI) and the stage of fibrosis were assessed according to the Ishak scoring system. Leica Q500IS image analyser was applied on Perl’s stained liver sections to assess the percentage of liver fibrosis. Results revealed that the median HAI decreased from 8.4 to 3.2 (p = 0.001), the median fibrosis score decreased from 3.8 to 2.3 (p = 0.001) and the median fibrosis percentage decreased from 28.7 to 12.8 (p = 0.001). These data demonstrate a significant improvement in fibrosis score in follow-up liver biopsies than initial diagnosis biopsies, in children who responded to immunosuppressant treatment and provide evidence for regression of fibrosis in AIH. Fibrosis control is associated with regression of necroinflammatory activity, which is the main treatment component in AIH.