Autoimmune Hepatitis

The liver is a large organ located in the right upper abdomen behind the rib cage. There are a variety of problems that can affect the liver such as viruses, alcohol, fat, medications, genetic disorders, and autoimmune diseases. Some of these may cause irritation or inflammation of the liver. Inflammation of the liver from any cause is called hepatitis.


The immune system consists of a variety of white blood cells that can help fight against infections including bacteria and viruses, foreign cells, or organs such as with transplants. Sometimes the immune system can be triggered to attack tissues in our own body. This is known as an autoimmune disease. In the case of autoimmune hepatitis the immune system mistakenly attacks cells in the liver. The factors that trigger the immune system to do this are unknown. Autoimmune hepatitis occurs mostly in women (70 %).


Symptoms of autoimmune hepatitis can include tiredness, muscle and joint aches, decreased appetite, nausea, vomiting, and right upper abdominal pain. If there is more serious liver injury patients may notice yellowing of the eyes and skin called jaundice, itching, abdominal swelling or confusion.


Liver blood tests are the initial tests that can indicate there is a liver problem. More specific blood tests looking for antibodies to one’s own tissues can be done. Examples of blood tests that are done when autoimmune hepatitis is suspected include anti-nuclear antibody (ANA), anti-smooth muscle antibody (ASMA) and anti-liver/kidney microsome (anti-LKM). A liver biopsy can also be helpful to diagnose autoimmune hepatitis and also to determine if there is any damage to the liver.


The treatment of autoimmune hepatitis consists of medications that decrease the activity of the immune system. Prednisone is commonly used in the treatment of autoimmune hepatitis. Another medicine called azathioprine (Imuran) is sometimes added to the treatment to further decrease the inflammation of the liver. These medicines can improve both symptoms and the liver blood tests. Prednisone has a number of potential side effects including insomnia, weight gain, diabetes, hypertension, and osteoporosis. The addition of azathioprine can help reduce the dose of prednisone. Azathioprine can cause a decrease in the blood cells (such as white blood cells) made by the bone marrow. Frequent blood testing (approximately monthly) is done to follow the blood counts closely. The lowest dose of medicines is used to try and lessen these potential side effects.

Patients with autoimmune hepatitis need to be monitored closely. As the symptoms and blood tests improve, the dosage of the medications can be slowly decreased. If the medications are discontinued some patients have a relapse of autoimmune hepatitis and may need to stay on medicines long-term to decrease the immune system. Autoimmune hepatitis can cause permanent scarring of the liver also known as cirrhosis. If a patient with cirrhosis shows signs of liver failure then liver transplantation may need to be considered.