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. 2022 May;42(5):1058-1069.
doi: 10.1111/liv.15217. Epub 2022 Mar 12.

Consensus recommendations for histological criteria of autoimmune hepatitis from the International AIH Pathology Group: Results of a workshop on AIH histology hosted by the European Reference Network on Hepatological Diseases and the European Society of Pathology: Results of a workshop on AIH histology hosted by the European Reference Network on Hepatological Diseases and the European Society of Pathology

Ansgar W Lohse  1   2 , Marcial Sebode  1   2 , Prithi S Bhathal  3 , Andrew D Clouston  4 , Hans P Dienes  5 , Dhanpat Jain  6 , Annette S H Gouw  7 , Maha Guindi  8 , Sanjay Kakar  9 , David E Kleiner  10 , Till Krech  11 , Carolin Lackner  12 , Thomas Longerich  13 , Romil Saxena  14 , Luigi Terracciano  15   16 , Kay Washington  17 , Sören Weidemann  11 , Stefan G Hübscher  18   19 , Dina Tiniakos  20   21
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Consensus recommendations for histological criteria of autoimmune hepatitis from the International AIH Pathology Group: Results of a workshop on AIH histology hosted by the European Reference Network on Hepatological Diseases and the European Society of Pathology: Results of a workshop on AIH histology hosted by the European Reference Network on Hepatological Diseases and the European Society of Pathology

Ansgar W Lohse et al. Liver Int. 2022 May.
Free article

Abstract

Background & aims: Diagnostic histological criteria for autoimmune hepatitis (AIH) have not been clearly established. Previously published criteria focused mainly on chronic AIH, in which inflammatory changes mainly occur in portal/periportal regions and may not be applicable to acute presentation of AIH, in which inflammatory changes are typically predominantly lobular in location. International consensus criteria for the diagnosis and assessment of disease severity in both acute and chronic AIH are thus urgently needed.

Methods: Seventeen expert liver pathologists convened at an international workshop and subsequently used a modified Delphi panel approach to establish consensus criteria for the histopathological diagnosis of AIH.

Results: The consensus view is that liver biopsy should remain standard for diagnosing AIH. AIH is considered likely, if there is a predominantly portal lymphoplasmacytic hepatitis with more than mild interface activity and/or more than mild lobular hepatitis in the absence of histological features suggestive of another liver disease. AIH is also considered likely if there is predominantly lobular hepatitis with or without centrilobular necroinflammation and at least one of the following features: portal lymphoplasmacytic hepatitis, interface hepatitis or portal-based fibrosis, in the absence of histological features suggestive of another liver disease. Emperipolesis and hepatocellular rosettes are not regarded as being specific for AIH.

Conclusions: The criteria proposed in this consensus statement provide a uniform approach to the histological diagnosis of AIH, which is relevant for patients with an acute as well as a chronic presentation and to more accurately reflect the current understanding of liver pathology in AIH.

Keywords: autoimmune hepatitis; histology; lobular hepatitis; portal hepatitis.

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References

REFERENCES

    1. Grønbaek L, Vilstrup H, Jepsen P. Autoimmune hepatitis in Denmark: incidence, prevalence, prognosis, and causes of death. A nationwide registry-based cohort study. J Hepatol. 2014;60:612-617. doi:10.1016/j.jhep.2013.10.020
    1. Johnson PJ, McFarlane IG. Meeting report: international autoimmune hepatitis group. Hepatology. 1993;18:998-1005. doi:10.1002/hep.1840180435
    1. Alvarez F, Berg PA, Bianchi FB, et al. International autoimmune hepatitis group report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999;31:929-938. doi:10.1016/s0168-8278(99)80297-9
    1. European Association for the Study of the Liver. EASL clinical practice guidelines: autoimmune hepatitis. J Hepatol. 2015;63:971-1004. doi:10.1016/j.jhep.2015.06.030
    1. Rahim MN, Miquel R, Heneghan MA. Approach to the patient with acute severe autoimmune hepatitis. JHEP Rep. 2020;2:100149. doi:10.1016/j.jhepr.2020.100149

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