The utility of repeat liver biopsy in autoimmune hepatitis: a series of 20 consecutive cases.

ABSTRACT

Liver biopsy is recommended to establish the diagnosis and to assess remission in autoimmune hepatitis (AIH) patients. The aim of our study was to assess the utility of repeat biopsy in AIH. Forty liver biopsies from 20 consecutive AIH patients who underwent repeat biopsy were evaluated. We assessed the biopsies for histological findings other than AIH and how often the repeat biopsy led to a change in clinical management. Furthermore, we correlated the changes in the laboratory findings with the histological features. AIH patients in the study were mostly female (80%; average age 58.7 years). The most common indications for repeat biopsy included elevated transaminases (40%) and evaluation prior to treatment alteration (40%). Seventy percent of the patients showed improved aminotransferase levels, which demonstrated no significant correlation with the inflammatory (p = 1.000) or fibrosis progression (p = 0.116). Forty percent of the patients showed pathology other than AIH in the repeat biopsies (3 steatohepatitis; 5 cholangiopathy features). Changes in the management were seen in all patients. Repeat biopsy is important in AIH patients as aminotransferase levels are not always a reliable marker for inflammatory and fibrosis progression. Moreover, liver biopsy is an effective method for diagnosing comorbid liver conditions.