Survival and histological resolution of fibrosis in patients with autoimmune chronic active hepatitis

Survival and long-term clinical and histological outcome were assessed retrospectively in 33 patients treated for autoimmune chronic active hepatitis. The Mayo Clinic treatment criteria were met by 30 of 33 patients and histological signs indicating nodular fibrosis and/or cirrhosis were present in 16 of 33 (48%). An overall 10-year survival rate of 90% was found by life-table analysis. This was not significantly different from matched controls (92%). Paired liver biopsies revealed that 16 of 28 (57%) patients improved their fibrosis/cirrhosis category whereas none progressed in a follow-up biopsy performed a median of 49 months later. Furthermore, liver biopsy showed improvement in 9 of 14 patients with initial nodular fibrosis/cirrhosis and resolution of nodulation. When a semi-quantitative scoring system was applied, the median fibrosis score improved significantly. A key factor intervening in the progression of fibrosis seemed to be the reduction of inflammatory activity as a result of immunosuppressive treatment. We conclude that fibrosis may be resolved in autoimmune chronic active hepatitis following protracted and effective treatment which is initiated early in the course of the disease.