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. 2018 Aug;6(7):1032-1038.
doi: 10.1177/2050640618768922. Epub 2018 Mar 30.

Real-world management of juvenile autoimmune liver disease

Y S de Boer  1 , R Liberal  2 , D Vergani  2 , G Mieli-Vergani  2   3
Affiliations

Real-world management of juvenile autoimmune liver disease

Y S de Boer et al. United European Gastroenterol J. 2018 Aug.

Abstract

Background and aims: Juvenile autoimmune liver disease (JAILD) includes paediatric forms of autoimmune hepatitis (AIH) and autoimmune sclerosing cholangitis (ASC). Since evidence is scarce, there are currently no evidence-based management guidelines for juvenile AIH. This survey was carried out amongst the paediatric members of the International AIH Group (IAIHG) to describe their practices in the management of JAILD.

Methods: An online survey questionnaire was distributed to members of the IAIHG with active practice (https://www.surveymonkey.de/r/Juvenile_AILD). The questionnaire consisted of four clinical scenarios on different presentations of AIH.

Results: Fifty-eight surveys were sent to the IAIHG members, out of which 43 (74%, 22 countries, four continents) were returned. None reported budesonide as a first-line induction agent for the acute presentation of AIH. Sixteen (37%) routinely perform liver biopsy at three years of biochemical remission. Thirty-five respondents (81%) perform magnetic resonance cholangiography (MRC) at presentation. Ciclosporin is the most widely used second-line agent (number of patients treated = ∼360, 21 centres). Mycophenolate mofetil (n = ∼225, 31 centres), tacrolimus (n = ∼130, 21 centres) and sirolimus (n = ∼5, 3 centres) are less often reported. Rescue therapy with infliximab and rituximab has been tried in eight centres (n = ∼19) and nine centres (n = ∼16), respectively.

Conclusions: Prednisolone remains the preferred first-line induction agent in JAILD. MRC at presentation is performed by the large majority of participants. Participants reported a wide variation in performing liver biopsy for therapy evaluation during follow-up. Within the paediatric members of the IAIHG there is considerable experience with second-line therapeutic agents.

Keywords: Autoimmune hepatitis; International Autoimmune Hepatitis Group; autoimmune sclerosing cholangitis; immunosuppression; liver transplantation.

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Figures

Figure 1.
Figure 1.
Reported number of paediatric patients treated with second-line therapies in the centres of participating paediatricians. MMF: mycophenolate mofetil.
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References

    1. Liberal R, Vergani D, Mieli-Vergani G. Paediatric autoimmune liver disease. Dig Dis 2015; 33(Suppl 2): 36–46. - PubMed
    1. Carbone M, Neuberger JM. Autoimmune liver disease, autoimmunity and liver transplantation. J Hepatol 2014; 60: 210–223. - PubMed
    1. Krawitt EL. Autoimmune hepatitis. N Engl J Med 2006; 354: 54–66. - PubMed
    1. Gregorio GV, Portmann B, Reid F, et al. Autoimmune hepatitis in childhood: A 20-year experience. Hepatology 1997; 25: 541–547. - PubMed
    1. Mieli-Vergani G, Vergani D. Autoimmune hepatitis. Nat Rev Gastroenterol Hepatol 2011; 8: 320–329. - PubMed

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