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Practice Guideline
. 2025 Dec;19(6):1275-1314.
doi: 10.1007/s12072-025-10925-0. Epub 2025 Nov 20.

Autoimmune hepatitis in children: Guidelines of the Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ISPGHAN)

Rajeev Khanna  1 , Bikrant Bihari Lal  1 , Vikrant Sood  1 , Seema Alam  2 , Aabha Nagral  3   4 , Aathira Ravindranath  5 , Aditi Kumar  6 , Aniket Deshmukh  7 , Anoop Saraya  8 , Anshu Srivastava  9 , Anupam Sibal  10 , Archana Rastogi  11 , Arjun Maria  12 , Arul Premanand Lionel  13 , Ashok Choudhury  8 , A Ashritha  14 , Bhaswati C Acharyya  15 , Cara L Mack  16 , Durga Prasad  17 , Geetha S Mammayil  18 , Ishaq Malik  19 , Jagadeesh Menon  20 , Jayendra Seetharaman  13 , John Matthai  21 , Kalpana Panda  22 , Karunesh Kumar  10 , Lalit Bharadia  23 , Marion Aw  24 , Malathi Sathiyasekaran  25 , Marianne Samyn  26 , Maya Peethambaran  27 , Moinak Sen Sarma  9 , Nagendra Kumar  28 , Nanda Kerkar  29 , Nirmala Dheivamani  30 , Parijat Ram Tripathi  31 , Piyush Upadhyay  32 , Prabhsaran Kaur  33 , Prasanth K Sobhan  34 , Rakhi Maiwall  8 , R Bhanu Vikraman Pillai  35 , Sadhna Lal  36 , Sakshi Karkra  37 , Shivani Deswal  38 , Snehavardhan Pandey  39 , Somashekara Hosaagrahara Ramakrishna  40 , Srikanth P Kadyada  41 , Srinivas Sankaranarayanan  42 , Surender Kumar Yachha  43 , Sumathi Bavanandam  44 , Sumit Kumar Singh  45 , Vaibhav Shah  46 , Vibhor Borkar  47 , Vikas Jain  48 , Vipul Gautam  49 , Viswanathan M Sivaramakrishnan  50 , Shiv Kumar Sarin  8
Affiliations
Practice Guideline

Autoimmune hepatitis in children: Guidelines of the Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ISPGHAN)

Rajeev Khanna et al. Hepatol Int. 2025 Dec.

Abstract

Autoimmune hepatitis (AIH) in children presents significant diagnostic and therapeutic challenges requiring a multidisciplinary and evidence-based approach. The Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ISPGHAN) convened a consensus meeting on February 23, 2025, bringing together national and international experts to address key clinical and research questions. The deliberations spanned epidemiology, clinical presentation, diagnosis including autoantibodies, immunoglobulin G (IgG), histology and diagnostic scores, therapeutic strategies, management of difficult-to-treat AIH, long-term monitoring, and special scenarios, such as seronegative AIH (SN-AIH), autoimmune sclerosing cholangitis/overlap syndromes and post-transplant complications like recurrence and de novo-AIH. Recommendations were formulated using standard GRADE system and finalized through structured consensus. These guidelines aim to standardize care, assist clinicians in decision-making, and improve outcomes in children with AIH across diverse healthcare settings.

Keywords: Autoantibodies; Autoimmune acute liver failure; Children; Chronic liver disease; Immunoglobulin; Liver transplantation.

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Conflict of interest statement

Declarations. Conflict of interest: Rajeev Khanna, Bikrant Bihari Lal, Vikrant Sood, Seema Alam, Aabha Nagral, Aathira Ravindranath, Aditi Kumar, Aniket Deshmukh, Anoop Saraya, Anshu Srivastava, Anupam Sibal, Archana Rastogi, Arjun Maria, Arul Premanand Lionel, Ashok Choudhury, A. Ashritha, Bhaswati C. Acharyya, Cara L. Mack, Durga Prasad, Geetha S. Mammayil, Ishaq Malik, Jagadeesh Menon, Jayendra Seetharaman, John Matthai, Kalpana Panda, Karunesh Kumar, Lalit Bharadia, Marion Aw, Malathi Sathiyasekaran, Marianne Samyn, Maya Peethambaran, Moinak Sen Sarma, Nagendra Kumar, Nanda Kerkar, Nirmala Dheivamani, Parijat Ram Tripathi, Piyush Upadhyay, Prabhsaran Kaur, Prasanth K. Sobhan, Rakhi Maiwall, R. Bhanu Vikraman Pillai, Sadhna Lal, Sakshi Karkra, Shivani Deswal, Snehavardhan Pandey, Somashekara Hosaagrahara Ramakrishna, Srikanth P. Kadyada, Srinivas Sankaranarayanan, Surender Kumar Yachha, Sumathi Bavanandam, Sumit Kumar Singh, Vaibhav Shah, Vibhor Borkar, Vikas Jain, Vipul Gautam, Viswanathan M. Sivaramakrishnan, and Shiv Kumar Sarin declare no conflict of interests.

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