Can liver biopsy be spared for the diagnosis of autoimmune hepatitis in selected children? A multicenter retrospective study
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Published on: May 29, 2020
Valeria Delle Cave1, Fabiola Di Dato1, Pier Luigi Calvo2
1Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy.
Insights
For children with autoimmune hepatitis (AIH), a definite AIH score before liver biopsy (LB) means the biopsy may be unnecessary for diagnosis. Histology and scoring systems do not predict AIH relapses or treatment withdrawal.
Area of Science:
- Pediatric Hepatology
- Autoimmune Liver Diseases
- Diagnostic Procedures
Background:
- Autoimmune hepatitis (AIH) diagnosis relies on clinical, biochemical, immunological, and histological data, often requiring liver biopsy (LB).
- Existing AIH scoring systems necessitate LB, posing risks and increasing healthcare burdens.
- Minimizing invasive procedures is crucial, especially in pediatric patients.
Purpose of the Study:
- To evaluate if liver biopsy can be omitted for diagnosing AIH in children with high pre-biopsy scores.
- To assess the utility of LB in confirming AIH diagnosis and predicting treatment outcomes.
Main Methods:
- Retrospective analysis of clinical, laboratory, imaging, and histological data from children with autoimmune liver disease (AILD).
- Application of AIH diagnostic scores (IAIHG, JAIH, s-IAIHG) pre- and post-LB.
- Comparison of diagnostic scores and histological findings with relapse rates and treatment withdrawal.
Main Results:
- Out of 91 pediatric patients, 15.3% (IAIHG), 49.5% (JAIH), and 0% (s-IAIHG) had "definite" AIH scores pre-LB.
- Diagnosis was confirmed post-LB in all patients with definite pre-LB scores.
- No correlation found between histological findings or diagnostic scores and AIH relapse or treatment withdrawal.
Conclusions:
- Liver biopsy is not essential for AIH diagnosis in pediatric patients who achieve a "definite" score pre-biopsy.
- Histological data and current scoring systems do not reliably predict AIH relapse or the need for treatment withdrawal.
Introduction And Objectives:
Autoimmune hepatitis (AIH) is diagnosed based on clinical, biochemical, immunological, and histological parameters, and on the exclusion of other liver diseases. Multiple scoring systems are available for AIH diagnosis, all of which require liver biopsy (LB). With the aim of reducing invasive procedures to minimize patient's risks, this study evaluated whether LB may be spared for AIH diagnosis in some children, similar to primary biliary cholangitis.
Materials And Methods:
Children with histologically confirmed autoimmune liver disease (AILD) were evaluated from 5 Pediatric Units. We retrospectively collected clinical, laboratory, imaging and histological data to assess AIH diagnostic scores (International Autoimmune Hepatitis Group [IAIHG] criteria, juvenile AIH score [JAIH], and simplified criteria [s-IAIHG]) in each patient pre- and post-LB. The diagnosis of autoimmune sclerosing cholangitis (ASC) was based on magnetic resonance cholangiopancreatography and liver histology.
Results:
Ninety-one patients (55 females) were evaluated (36 with AIH type I, 24 with AIH type II, 8 with seronegative AIH, and 23 with ASC). The mean age at diagnosis and duration of follow-up were 8.9 ± 4.8 and 9.6 ± 7.8 years, respectively. Based on IAIHG, JAIH and s-IAIHG scores, pre-LB scores were "definite" for 15.3%, 49.5%, and 0% of patients, respectively. Post-LB, the diagnosis was confirmed in all these patients. We found no associations between liver histological findings or diagnostic scores and relapses or treatment withdrawal.
Conclusions:
In patients with a "definite" AIH score pre-LB, LB is not necessary for diagnosis. Histological findings and scoring systems do not predict relapses or treatment withdrawal.
