Improvement of the histopathology on a maintenance regimen in children with autoimmune hepatitis.

Autoimmune hepatitis (AIH) is a chronic liver disease characterized histologically by interface hepatitis and fibrosis. Recent studies have reported that hepatic fibrosis and cirrhosis may be reversible by treatment in some patients. Combined low dose prednisolone and azathioprine regimen was rarely studied in children with AIH. Twenty children with median age 8±3.5 yrs (9 girls, 11 boys), 18 AIH type I and two were AIH type II, who were in clinical and biochemical remission for at least 6 months, and who had a diagnostic and a follow-up liver biopsy, were included in this study. Different histological stains were used for assessing the grade of necroinflammatory activity (HAI) and for evaluating the stage of fibrosis according to Ishak scoring system. Morphometric analysis using LeicaQ500IS image analyzer was applied on Perl's stained liver sections to assess the percentage of liver fibrosis. Data revealed significant decrease in the median HAI from 8.85 to 3.6 (p=0.001). The median fibrosis score showed significant reduction from 3.9 to 2.4 (p=0.001) and the median fibrosis percentage decreased from 28.7 to 12.8 (p=0.001). These data provide evidence for regression of fibrosis in AIH in children who responded to the combined low dose immunosuppressive prednisolone and azothioprine regimen.