Download PDF
Semin Liver Dis 2009; 29(3): 315-330
DOI: 10.1055/s-0029-1233530
© Thieme Medical Publishers

Special Clinical Challenges in Autoimmune Hepatitis: The Elderly, Males, Pregnancy, Mild Disease, Fulminant Onset, and Nonwhite Patients

Albert J. Czaja1
  • 1Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
Further Information

Publication History

Publication Date:
12 August 2009 (online)

    Permissions and Reprints

ABSTRACT

Autoimmune hepatitis has diverse presentations that may mask its identity, affect its clinical behavior, and confound its management. The objectives of this report are to characterize the populations that are underdiagnosed or difficult to manage and to provide guidelines for meeting their challenges. The elderly have an aggressive, indolent liver disease that responds well to conventional corticosteroid treatment, but the diagnosis of this disease can be hampered by concurrent illnesses and medication. Genetic factors affect the expression and outcome of autoimmune hepatitis in different genders, and they may influence the nature and reactivity to triggering antigens or hormonal imbalances. Pregnancy can ameliorate autoimmune hepatitis, whereas delivery can exacerbate it. Asymptomatic patients and those with mild laboratory derangements may not require immediate therapy, but they commonly require treatment later. Centrilobular zone 3 necrosis can characterize an acute, severe, or fulminant presentation, and corticosteroid therapy can be lifesaving if effective within 2 weeks. Region-specific etiological agents, host-dependent susceptibility factors, and socioeconomic conditions may diversify the presentation in different ethnic groups. The special clinical challenges are essential to recognize and treat properly, and they may also extend hypotheses of pathogenesis.

KEYWORDS

Diagnostic difficulties - treatment recommendations - variant presentations

REFERENCES

  • 1 Czaja A J. Diverse manifestations and evolving treatments of autoimmune hepatitis.  Minerva Gastroenterol Dietol. 2005;  51(4) 313-333
    PubMedGoogle Scholar
  • 2 Czaja A J, Freese D K. American Association for the Study of Liver Disease . Diagnosis and treatment of autoimmune hepatitis.  Hepatology. 2002;  36(2) 479-497
    CrossrefPubMedGoogle Scholar
  • 3 Alvarez F, Berg P A, Bianchi F B et al.. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis.  J Hepatol. 1999;  31(5) 929-938
    CrossrefPubMedGoogle Scholar
  • 4 Hennes E M, Zeniya M, Czaja A J et al.. Simplified diagnostic criteria for the diagnosis of autoimmune hepatitis.  Hepatology. 2008;  48 169-176
    CrossrefPubMedGoogle Scholar
  • 5 Czaja A J. Performance parameters of the diagnostic scoring systems for autoimmune hepatitis.  Hepatology. 2008;  48(5) 1540-1548
    CrossrefPubMedGoogle Scholar
  • 6 Crapper R M, Bhathal P S, Mackay I R, Frazer I H. ‘Acute’ autoimmune hepatitis.  Digestion. 1986;  34(3) 216-225
    CrossrefPubMedGoogle Scholar
  • 7 Amontree J S, Stuart T D, Bredfeldt J E. Autoimmune chronic active hepatitis masquerading as acute hepatitis.  J Clin Gastroenterol. 1989;  11(3) 303-307
    PubMedGoogle Scholar
  • 8 Nikias G A, Batts K P, Czaja A J. The nature and prognostic implications of autoimmune hepatitis with an acute presentation.  J Hepatol. 1994;  21(5) 866-871
    CrossrefPubMedGoogle Scholar
  • 9 Singh R, Nair S, Farr G, Mason A, Perrillo R. Acute autoimmune hepatitis presenting with centrizonal liver disease: case report and review of the literature.  Am J Gastroenterol. 2002;  97(10) 2670-2673
    CrossrefPubMedGoogle Scholar
  • 10 Okano N, Yamamoto K, Sakaguchi K et al.. Clinicopathological features of acute-onset autoimmune hepatitis.  Hepatol Res. 2003;  25(3) 263-270
    PubMedGoogle Scholar
  • 11 Kanda T, Yokosuka O, Hirasawa Y et al.. Acute-onset autoimmune hepatitis resembling acute hepatitis: a case report and review of reported cases.  Hepatogastroenterology. 2005;  52(64) 1233-1235
    PubMedGoogle Scholar
  • 12 Maggiore G, Porta G, Bernard O et al.. Autoimmune hepatitis with initial presentation as acute hepatic failure in young children.  J Pediatr. 1990;  116(2) 280-282
    PubMedGoogle Scholar
  • 13 Herzog D, Rasquin-Weber A M, Debray D, Alvarez F. Subfulminant hepatic failure in autoimmune hepatitis type 1: an unusual form of presentation.  J Hepatol. 1997;  27(3) 578-582
    CrossrefPubMedGoogle Scholar
  • 14 Viruet E J, Torres E A. Steroid therapy in fulminant hepatic failure secondary to autoimmune hepatitis.  P R Health Sci J. 1998;  17(3) 297-300
    PubMedGoogle Scholar
  • 15 Kessler W R, Cummings O W, Eckert G, Chalasani N, Lumeng L, Kwo P Y. Fulminant hepatic failure as the initial presentation of acute autoimmune hepatitis.  Clin Gastroenterol Hepatol. 2004;  2(7) 625-631
    CrossrefPubMedGoogle Scholar
  • 16 Miyake Y, Iwasaki Y, Terada R et al.. Clinical characteristics of fulminant-type autoimmune hepatitis: an analysis of eleven cases.  Aliment Pharmacol Ther. 2006;  23(9) 1347-1353
    CrossrefPubMedGoogle Scholar
  • 17 Ichai P, Duclos-Vallée J-C, Guettier C et al.. Usefulness of corticosteroids for the treatment of severe and fulminant forms of autoimmune hepatitis.  Liver Transpl. 2007;  13(7) 996-1003
    CrossrefPubMedGoogle Scholar
  • 18 Kogan J, Safadi R, Ashur Y, Shouval D, Ilan Y. Prognosis of symptomatic versus asymptomatic autoimmune hepatitis: a study of 68 patients.  J Clin Gastroenterol. 2002;  35(1) 75-81
    CrossrefPubMedGoogle Scholar
  • 19 Feld J J, Dinh H, Arenovich T, Marcus V A, Wanless I R, Heathcote E J. Autoimmune hepatitis: effect of symptoms and cirrhosis on natural history and outcome.  Hepatology. 2005;  42(1) 53-62
    CrossrefPubMedGoogle Scholar
  • 20 Czaja A J. Features and consequences of untreated type 1 autoimmune hepatitis.  Liver Int. 2009;  29(6) 816-823
    CrossrefPubMedGoogle Scholar
  • 21 Bittencourt P L, Farias A Q, Porta G et al.. Frequency of concurrent autoimmune disorders in patients with autoimmune hepatitis: effect of age, gender, and genetic background.  J Clin Gastroenterol. 2008;  42(3) 300-305
    PubMedGoogle Scholar
  • 22 Czaja A J. Behavior and significance of autoantibodies in type 1 autoimmune hepatitis.  J Hepatol. 1999;  30(3) 394-401
    CrossrefPubMedGoogle Scholar
  • 23 Czaja A J, Hay J E, Rakela J. Clinical features and prognostic implications of severe corticosteroid-treated cryptogenic chronic active hepatitis.  Mayo Clin Proc. 1990;  65(1) 23-30
    PubMedGoogle Scholar
  • 24 Czaja A J, Carpenter H A, Santrach P J, Moore S B, Homburger H A. The nature and prognosis of severe cryptogenic chronic active hepatitis.  Gastroenterology. 1993;  104(6) 1755-1761
    PubMedGoogle Scholar
  • 25 Baeres M, Herkel J, Czaja A J et al.. Establishment of standardised SLA/LP immunoassays: specificity for autoimmune hepatitis, worldwide occurrence, and clinical characteristics.  Gut. 2002;  51(2) 259-264
    CrossrefPubMedGoogle Scholar
  • 26 Gassert D J, Garcia H, Tanaka K, Reinus J F. Corticosteroid-responsive cryptogenic chronic hepatitis: evidence for seronegative autoimmune hepatitis.  Dig Dis Sci. 2007;  52(9) 2433-2437
    CrossrefPubMedGoogle Scholar
  • 27 Pratt D S, Fawaz K A, Rabson A, Dellelis R, Kaplan M M. A novel histological lesion in glucocorticoid-responsive chronic hepatitis.  Gastroenterology. 1997;  113(2) 664-668
    CrossrefPubMedGoogle Scholar
  • 28 Misdraji J, Thiim M, Graeme-Cook F M. Autoimmune hepatitis with centrilobular necrosis.  Am J Surg Pathol. 2004;  28(4) 471-478
    CrossrefPubMedGoogle Scholar
  • 29 Hofer H, Oesterreicher C, Wrba F, Ferenci P, Penner E. Centrilobular necrosis in autoimmune hepatitis: a histological feature associated with acute clinical presentation.  J Clin Pathol. 2006;  59(3) 246-249
    CrossrefPubMedGoogle Scholar
  • 30 Miyake Y, Iwasaki Y, Terada R et al.. Clinical features of Japanese type 1 autoimmune hepatitis patients with zone III necrosis.  Hepatol Res. 2007;  37(10) 801-805
    PubMedGoogle Scholar
  • 31 Zen Y, Notsumata K, Tanaka N, Nakanuma Y. Hepatic centrilobular zonal necrosis with positive antinuclear antibody: a unique subtype or early disease of autoimmune hepatitis?.  Hum Pathol. 2007;  38(11) 1669-1675
    CrossrefPubMedGoogle Scholar
  • 32 Iwai M, Jo M, Ishii M, Mori T, Harada Y. Comparison of clinical features and liver histology in acute and chronic autoimmune hepatitis.  Hepatol Res. 2008;  38(8) 784-789
    PubMedGoogle Scholar
  • 33 Ben-Ari Z, Dhillon A P, Sherlock S. Autoimmune cholangiopathy: part of the spectrum of autoimmune chronic active hepatitis.  Hepatology. 1993;  18(1) 10-15
    CrossrefPubMedGoogle Scholar
  • 34 Czaja A J, Carpenter H A, Santrach P J, Moore S B. Autoimmune cholangitis within the spectrum of autoimmune liver disease.  Hepatology. 2000;  31(6) 1231-1238
    CrossrefPubMedGoogle Scholar
  • 35 Czaja A J, Carpenter H A. Autoimmune hepatitis with incidental histologic features of bile duct injury.  Hepatology. 2001;  34(4 Pt 1) 659-665
    CrossrefPubMedGoogle Scholar
  • 36 Czaja A J, Muratori P, Muratori L, Carpenter H A, Bianchi F B. Diagnostic and therapeutic implications of bile duct injury in autoimmune hepatitis.  Liver Int. 2004;  24(4) 322-329
    CrossrefPubMedGoogle Scholar
  • 37 Lim K N, Casanova R L, Boyer T D, Bruno C J. Autoimmune hepatitis in African Americans: presenting features and response to therapy.  Am J Gastroenterol. 2001;  96(12) 3390-3394
    CrossrefPubMedGoogle Scholar
  • 38 Verma S, Torbenson M, Thuluvath P J. The impact of ethnicity on the natural history of autoimmune hepatitis.  Hepatology. 2007;  46(6) 1828-1835
    CrossrefPubMedGoogle Scholar
  • 39 Flores Y N, Yee Jr H F, Leng M et al.. Risk factors for chronic liver disease in Blacks, Mexican Americans, and Whites in the United States: results from NHANES IV, 1999-2004.  Am J Gastroenterol. 2008;  103(9) 2231-2238
    CrossrefPubMedGoogle Scholar
  • 40 Nguyen G C, Thuluvath P J. Racial disparity in liver disease: biological, cultural, or socioeconomic factors.  Hepatology. 2008;  47(3) 1058-1066
    CrossrefPubMedGoogle Scholar
  • 41 Czaja A J. Genetic factors affecting the occurrence, clinical phenotype, and outcome of autoimmune hepatitis.  Clin Gastroenterol Hepatol. 2008;  6(4) 379-388
    CrossrefPubMedGoogle Scholar
  • 42 Siegel A B, McBride R B, El-Serag H B et al.. Racial disparities in utilization of liver transplantation for hepatocellular carcinoma in the United States, 1998-2002.  Am J Gastroenterol. 2008;  103(1) 120-127
    PubMedGoogle Scholar
  • 43 Czaja A J, Donaldson P T. Gender effects and synergisms with histocompatibility leukocyte antigens in type 1 autoimmune hepatitis.  Am J Gastroenterol. 2002;  97(8) 2051-2057
    CrossrefPubMedGoogle Scholar
  • 44 Al-Chalabi T, Underhill J A, Portmann B C, McFarlane I G, Heneghan M A. Impact of gender on the long-term outcome and survival of patients with autoimmune hepatitis.  J Hepatol. 2008;  48(1) 140-147
    CrossrefPubMedGoogle Scholar
  • 45 Lebovics E, Schaffner F, Klion F M, Simon C. Autoimmune chronic active hepatitis in postmenopausal women.  Dig Dis Sci. 1985;  30(9) 824-828
    CrossrefPubMedGoogle Scholar
  • 46 Wang K K, Czaja A J. Prognosis of corticosteroid-treated hepatitis B surface antigen-negative chronic active hepatitis in postmenopausal women: a retrospective analysis.  Gastroenterology. 1989;  97(5) 1288-1293
    PubMedGoogle Scholar
  • 47 Schramm C, Kanzler S, zum Büschenfelde K H, Galle P R, Lohse A W. Autoimmune hepatitis in the elderly.  Am J Gastroenterol. 2001;  96(5) 1587-1591
    CrossrefPubMedGoogle Scholar
  • 48 Granito A, Muratori L, Pappas G et al.. Clinical features of type 1 autoimmune hepatitis in elderly Italian patients.  Aliment Pharmacol Ther. 2005;  21(10) 1273-1277
    CrossrefPubMedGoogle Scholar
  • 49 Verslype C, George C, Buchel E, Nevens F, van Steenbergen W, Fevery J. Diagnosis and treatment of autoimmune hepatitis at age 65 and older.  Aliment Pharmacol Ther. 2005;  21(6) 695-699
    CrossrefPubMedGoogle Scholar
  • 50 Al-Chalabi T, Boccato S, Portmann B C, McFarlane I G, Heneghan M A. Autoimmune hepatitis (AIH) in the elderly: a systematic retrospective analysis of a large group of consecutive patients with definite AIH followed at a tertiary referral centre.  J Hepatol. 2006;  45(4) 575-583
    CrossrefPubMedGoogle Scholar
  • 51 Czaja A J, Carpenter H A. Distinctive clinical phenotype and treatment outcome of type 1 autoimmune hepatitis in the elderly.  Hepatology. 2006;  43(3) 532-538
    CrossrefPubMedGoogle Scholar
  • 52 Miyake T, Miyaoka H, Abe M et al.. Clinical characteristics of autoimmune hepatitis in older aged patients.  Hepatol Res. 2006;  36(2) 139-142
    PubMedGoogle Scholar
  • 53 Czaja A J. Clinical features, differential diagnosis and treatment of autoimmune hepatitis in the elderly.  Drugs Aging. 2008;  25(3) 219-239
    CrossrefPubMedGoogle Scholar
  • 54 Varma R R, Michelsohn N H, Borkowf H I, Lewis J D. Pregnancy in cirrhotic and noncirrhotic portal hypertension.  Obstet Gynecol. 1977;  50(2) 217-222
    PubMedGoogle Scholar
  • 55 Steven M M, Buckley J D, Mackay I R. Pregnancy in chronic active hepatitis.  Q J Med. 1979;  48(192) 519-531
    PubMedGoogle Scholar
  • 56 Heneghan M A, Norris S M, O'Grady J G, Harrison P M, McFarlane I G. Management and outcome of pregnancy in autoimmune hepatitis.  Gut. 2001;  48(1) 97-102
    CrossrefPubMedGoogle Scholar
  • 57 Buchel E, Van Steenbergen W, Nevens F, Fevery J. Improvement of autoimmune hepatitis during pregnancy followed by flare-up after delivery.  Am J Gastroenterol. 2002;  97(12) 3160-3165
    CrossrefPubMedGoogle Scholar
  • 58 Candia L, Marquez J, Espinoza L R. Autoimmune hepatitis and pregnancy: a rheumatologist's dilemma.  Semin Arthritis Rheum. 2005;  35(1) 49-56
    CrossrefPubMedGoogle Scholar
  • 59 Schramm C, Herkel J, Beuers U, Kanzler S, Galle P R, Lohse A W. Pregnancy in autoimmune hepatitis: outcome and risk factors.  Am J Gastroenterol. 2006;  101(3) 556-560
    CrossrefPubMedGoogle Scholar
  • 60 de Boer N K, Jarbandhan S V, de Graaf P, Mulder C J, van Elburg R M, van Bodegraven A A. Azathioprine use during pregnancy: unexpected intrauterine exposure to metabolites.  Am J Gastroenterol. 2006;  101(6) 1390-1392
    CrossrefPubMedGoogle Scholar
  • 61 Werner M, Björnsson E, Prytz H et al.. Autoimmune hepatitis among fertile women: strategies during pregnancy and breastfeeding?.  Scand J Gastroenterol. 2007;  42(8) 986-991
    CrossrefPubMedGoogle Scholar
  • 62 Czaja A J. Safety issues in the management of autoimmune hepatitis.  Expert Opin Drug Saf. 2008;  7(3) 319-333
    CrossrefPubMedGoogle Scholar
  • 63 Czaja A J. Understanding the pathogenesis of autoimmune hepatitis.  Am J Gastroenterol. 2001;  96(4) 1224-1231
    CrossrefPubMedGoogle Scholar
  • 64 Vergani D, Choudhuri K, Bogdanos D P, Mieli-Vergani G. Pathogenesis of autoimmune hepatitis.  Clin Liver Dis. 2002;  6(3) 727-737
    CrossrefPubMedGoogle Scholar
  • 65 Manns M P, Vogel A. Autoimmune hepatitis, from mechanisms to therapy.  Hepatology. 2006;  43(2, Suppl 1) S132-S144
    CrossrefPubMedGoogle Scholar
  • 66 Lapierre P, Béland K, Alvarez F. Pathogenesis of autoimmune hepatitis: from break of tolerance to immune-mediated hepatocyte apoptosis.  Transl Res. 2007;  149(3) 107-113
    PubMedGoogle Scholar
  • 67 Czaja A J. Autoimmune hepatitis. Part A: pathogenesis.  Expert Rev Gastroenterol Hepatol. 2007;  1(1) 113-128
    CrossrefPubMedGoogle Scholar
  • 68 Vergani D, Mieli-Vergani G. Aetiopathogenesis of autoimmune hepatitis.  World J Gastroenterol. 2008;  14(21) 3306-3312
    CrossrefPubMedGoogle Scholar
  • 69 Czaja A J. Progress in the diagnosis and treatment of autoimmune hepatitis.  Minerva Med. 2008;  99(6) 549-568
    PubMedGoogle Scholar
  • 70 Czaja A J, Bianchi F B, Carpenter H A et al.. Treatment challenges and investigational opportunities in autoimmune hepatitis.  Hepatology. 2005;  41(1) 207-215
    CrossrefPubMedGoogle Scholar
  • 71 Newton J L, Burt A D, Park J B, Mathew J, Bassendine M F, James O FW. Autoimmune hepatitis in older patients.  Age Ageing. 1997;  26(6) 441-444
    CrossrefPubMedGoogle Scholar
  • 72 Parker D R, Kingham J G. Type 1 autoimmune hepatitis is primarily a disease of later life.  QJM. 1997;  90 289-296
    CrossrefPubMedGoogle Scholar
  • 73 Burgart L J, Batts K P, Ludwig J, Nikias G A, Czaja A J. Recent-onset autoimmune hepatitis. Biopsy findings and clinical correlations.  Am J Surg Pathol. 1995;  19(6) 699-708
    PubMedGoogle Scholar
  • 74 Czaja A J. Autoimmune liver disease and rheumatic manifestations.  Curr Opin Rheumatol. 2007;  19(1) 74-80
    PubMedGoogle Scholar
  • 75 Volta U, De Franceschi L, Lari F, Molinaro N, Zoli M, Bianchi F B. Coeliac disease hidden by cryptogenic hypertransaminasaemia.  Lancet. 1998;  352(9121) 26-29
    CrossrefPubMedGoogle Scholar
  • 76 Volta U, De Franceschi L, Molinaro N et al.. Frequency and significance of anti-gliadin and anti-endomysial antibodies in autoimmune hepatitis.  Dig Dis Sci. 1998;  43(10) 2190-2195
    CrossrefPubMedGoogle Scholar
  • 77 Kaukinen K, Halme L, Collin P et al.. Celiac disease in patients with severe liver disease: gluten-free diet may reverse hepatic failure.  Gastroenterology. 2002;  122(4) 881-888
    CrossrefPubMedGoogle Scholar
  • 78 Sedlack R E, Smyrk T C, Czaja A J, Talwalkar J A. Celiac disease-associated autoimmune cholangitis.  Am J Gastroenterol. 2002;  97(12) 3196-3198
    CrossrefPubMedGoogle Scholar
  • 79 Abdo A, Meddings J, Swain M. Liver abnormalities in celiac disease.  Clin Gastroenterol Hepatol. 2004;  2(2) 107-112
    CrossrefPubMedGoogle Scholar
  • 80 Stevens F M, McLoughlin R M. Is coeliac disease a potentially treatable cause of liver failure?.  Eur J Gastroenterol Hepatol. 2005;  17(10) 1015-1017
    CrossrefPubMedGoogle Scholar
  • 81 Caprai S, Vajro P, Ventura A, Sciveres M, Maggiore G. SIGENP Study Group for Autoimmune Liver Disorders in Celiac Disease . Autoimmune liver disease associated with celiac disease in childhood: a multicenter study.  Clin Gastroenterol Hepatol. 2008;  6(7) 803-806
    CrossrefPubMedGoogle Scholar
  • 82 Cosnes J, Cellier C, Viola S Groupe D'Etude et de Recherche Sur la Maladie Coeliaque et al. Incidence of autoimmune diseases in celiac disease: protective effect of the gluten-free diet.  Clin Gastroenterol Hepatol. 2008;  6(7) 753-758
    CrossrefPubMedGoogle Scholar
  • 83 Hall S, Czaja A J, Kaufman D K, Markowitz H, Ginsburg W W. How lupoid is lupoid hepatitis?.  J Rheumatol. 1986;  13(1) 95-98
    PubMedGoogle Scholar
  • 84 Abraham S, Begum S, Isenberg D. Hepatic manifestations of autoimmune rheumatic diseases.  Ann Rheum Dis. 2004;  63 123-129
    CrossrefPubMedGoogle Scholar
  • 85 Czaja A J, Manns M P, Homburger H A. Frequency and significance of antibodies to liver/kidney microsome type 1 in adults with chronic active hepatitis.  Gastroenterology. 1992;  103(4) 1290-1295
    PubMedGoogle Scholar
  • 86 Homberg J-C, Abuaf N, Bernard O et al.. Chronic active hepatitis associated with antiliver/kidney microsome antibody type 1: a second type of “autoimmune” hepatitis.  Hepatology. 1987;  7(6) 1333-1339
    PubMedGoogle Scholar
  • 87 Czaja A J, Kruger M, Santrach P J, Moore S B, Manns M P. Genetic distinctions between types 1 and 2 autoimmune hepatitis.  Am J Gastroenterol. 1997;  92(12) 2197-2200
    PubMedGoogle Scholar
  • 88 Bittencourt P L, Goldberg A C, Cançado E LR et al.. Genetic heterogeneity in susceptibility to autoimmune hepatitis types 1 and 2.  Am J Gastroenterol. 1999;  94(7) 1906-1913
    CrossrefPubMedGoogle Scholar
  • 89 Ma Y, Bogdanos D P, Hussain M J et al.. Polyclonal T-cell responses to cytochrome P450IID6 are associated with disease activity in autoimmune hepatitis type 2.  Gastroenterology. 2006;  130(3) 868-882
    CrossrefPubMedGoogle Scholar
  • 90 Muratori P, Czaja A J, Muratori L et al.. Evidence of a genetic basis for the different geographic occurrences of liver/kidney microsomal antibody type 1 in hepatitis C.  Dig Dis Sci. 2007;  52(1) 179-184
    CrossrefPubMedGoogle Scholar
  • 91 Djilali-Saiah I, Fakhfakh A, Louafi H, Caillat-Zucman S, Debray D, Alvarez F. HLA class II influences humoral autoimmunity in patients with type 2 autoimmune hepatitis.  J Hepatol. 2006;  45(6) 844-850
    CrossrefPubMedGoogle Scholar
  • 92 Czaja A J, Carpenter H A, Moore S B. Clinical and HLA phenotypes of type 1 autoimmune hepatitis in North American patients outside DR3 and DR4.  Liver Int. 2006;  26(5) 552-558
    CrossrefPubMedGoogle Scholar
  • 93 Czaja A J, Norman G L. Autoantibodies in the diagnosis and management of liver disease.  J Clin Gastroenterol. 2003;  37(4) 315-329
    CrossrefPubMedGoogle Scholar
  • 94 Czaja A J. Treatment strategies in autoimmune hepatitis.  Clin Liver Dis. 2002;  6(3) 799-824
    CrossrefPubMedGoogle Scholar
  • 95 Czaja A J. Treatment of autoimmune hepatitis.  Semin Liver Dis. 2002;  22(4) 365-378
    Article in Thieme ConnectPubMedGoogle Scholar
  • 96 Montano Loza A J, Czaja A J. Current therapy for autoimmune hepatitis.  Nat Clin Pract Gastroenterol Hepatol. 2007;  4(4) 202-214
    CrossrefPubMedGoogle Scholar
  • 97 Czaja A J. Evolving concepts in the diagnosis, pathogenesis and treatment of autoimmune hepatitis.  Minerva Gastroenterol Dietol. 2007;  53(1) 43-78
    PubMedGoogle Scholar
  • 98 Luxon B A. Diagnosis and treatment of autoimmune hepatitis.  Gastroenterol Clin North Am. 2008;  37(2) 461-478, vii–viii
    CrossrefPubMedGoogle Scholar
  • 99 Larsen F S. Treatment of patients with severe autoimmune hepatitis.  Minerva Gastroenterol Dietol. 2008;  54(1) 57-63
    PubMedGoogle Scholar
  • 100 Collier J. Bone disorders in chronic liver disease.  Hepatology. 2007;  46(4) 1271-1278
    CrossrefPubMedGoogle Scholar
  • 101 Stellon A J, Keating J J, Johnson P J, McFarlane I G, Williams R. Maintenance of remission in autoimmune chronic active hepatitis with azathioprine after corticosteroid withdrawal.  Hepatology. 1988;  8(4) 781-784
    PubMedGoogle Scholar
  • 102 Johnson P J, McFarlane I G, Williams R. Azathioprine for long-term maintenance of remission in autoimmune hepatitis.  N Engl J Med. 1995;  333(15) 958-963
    CrossrefPubMedGoogle Scholar
  • 103 Wörns M A, Teufel A, Kanzler S et al.. Incidence of HAV and HBV infections and vaccination rates in patients with autoimmune liver diseases.  Am J Gastroenterol. 2008;  103(1) 138-146
    PubMedGoogle Scholar
  • 104 Cross T JS, Antoniades C G, Muiesan P et al.. Liver transplantation in patients over 60 and 65 years: an evaluation of long-term outcomes and survival.  Liver Transpl. 2007;  13(10) 1382-1388
    CrossrefPubMedGoogle Scholar
  • 105 De Paoli P, Battistin S, Santini G F. Age-related changes in human lymphocyte subsets: progressive reduction of the CD4 CD45R (suppressor inducer) population.  Clin Immunol Immunopathol. 1988;  48(3) 290-296
    CrossrefPubMedGoogle Scholar
  • 106 Schwab R, Russo C, Weksler M E. Altered major histocompatibility complex-restricted antigen recognition by T cells from elderly humans.  Eur J Immunol. 1992;  22(11) 2989-2993
    CrossrefPubMedGoogle Scholar
  • 107 Murasko D M, Goonewardene I M. T-cell function in aging: mechanisms of decline.  Annu Rev Gerontol Geriatr. 1990;  10 71-96
    PubMedGoogle Scholar
  • 108 Talor E, Rose N R. Hypothesis: the aging paradox and autoimmune disease.  Autoimmunity. 1991;  8(3) 245-249
    PubMedGoogle Scholar
  • 109 Currie M S. Immunosenescence.  Compr Ther. 1992;  18(11) 26-34
    PubMedGoogle Scholar
  • 110 Ben-Yehuda A, Weksler M E. Immune senescence: mechanisms and clinical implications.  Cancer Invest. 1992;  10(6) 525-531
    CrossrefPubMedGoogle Scholar
  • 111 Rowley M J, Buchanan H, Mackay I R. Reciprocal change with age in antibody to extrinsic and intrinsic antigens.  Lancet. 1968;  2 24-26
    PubMedGoogle Scholar
  • 112 Paganelli R, Quinti I, Fagiolo U et al.. Changes in circulating B cells and immunoglobulin classes and subclasses in a healthy aged population.  Clin Exp Immunol. 1992;  90(2) 351-354
    PubMedGoogle Scholar
  • 113 Hooper B, Whittingham S, Mathews J D, Mackay I R, Curnow D H. Autoimmunity in a rural community.  Clin Exp Immunol. 1972;  12(1) 79-87
    PubMedGoogle Scholar
  • 114 Bach J-F. The effect of infections on susceptibility to autoimmune and allergic diseases.  N Engl J Med. 2002;  347(12) 911-920
    CrossrefPubMedGoogle Scholar
  • 115 Vrieling H, Tates A D, Natarajan A T, van Zeeland A A. Age-related accumulation of mutations in human T-lymphocytes.  Ann N Y Acad Sci. 1992;  663 36-42
    CrossrefPubMedGoogle Scholar
  • 116 Czaja A J, dos Santos R M, Porto A, Santrach P J, Moore S B. Immune phenotype of chronic liver disease.  Dig Dis Sci. 1998;  43(9) 2149-2155
    CrossrefPubMedGoogle Scholar
  • 117 Boberg K M, Aadland E, Jahnsen J, Raknerud N, Stiris M, Bell H. Incidence and prevalence of primary biliary cirrhosis, primary sclerosing cholangitis, and autoimmune hepatitis in a Norwegian population.  Scand J Gastroenterol. 1998;  33(1) 99-103
    CrossrefPubMedGoogle Scholar
  • 118 Werner M, Prytz H, Ohlsson B et al.. Epidemiology and the initial presentation of autoimmune hepatitis in Sweden: a nationwide study.  Scand J Gastroenterol. 2008;  43(10) 1232-1240
    CrossrefPubMedGoogle Scholar
  • 119 Rowley M J, Mackay I R. Measurement of antibody-producing capacity in man. I. The normal response to flagellin from Salmonella adelaide .  Clin Exp Immunol. 1969;  5(4) 407-418
    PubMedGoogle Scholar
  • 120 Eidinger D, Garrett T J. Studies of the regulatory effects of the sex hormones on antibody formation and stem cell differentiation.  J Exp Med. 1972;  136(5) 1098-1116
    CrossrefPubMedGoogle Scholar
  • 121 Mackay I R, Wittingham S, Tait B. Genetic control of immune responsiveness in man.  Vox Sang. 1977;  32(1) 10-19
    CrossrefPubMedGoogle Scholar
  • 122 Lahita R G. The connective tissue diseases and the overall influence of gender.  Int J Fertil Menopausal Stud. 1996;  41 156-165
    PubMedGoogle Scholar
  • 123 Whitacre C C, Reingold S C, O'Looney P A. A gender gap in autoimmunity.  Science. 1999;  283(5406) 1277-1278
    CrossrefPubMedGoogle Scholar
  • 124 McFarlane I G, Heneghan M A. Autoimmunity and the female liver.  Hepatol Res. 2004;  28(4) 171-176
    PubMedGoogle Scholar
  • 125 Tong M J, Hsieh J, Blatt L M. Demographics, treatment and a predictive model of survival in a population of chronic autoimmune hepatitis patients.  Hepatology. 1998;  28 549A
    PubMedGoogle Scholar
  • 126 Heneghan M A, Kosar Y, McDougall N I, Portmann B, McFarlane I G, Harrison P M. Characteristics and outcome of a large male cohort with autoimmune hepatitis: prognostic indicator of treatment response and outcome.  Gastroenterology. 2000;  118 A1009
    PubMedGoogle Scholar
  • 127 Czaja A J, Carpenter H A, Santrach P J, Moore S B. Significance of HLA DR4 in type 1 autoimmune hepatitis.  Gastroenterology. 1993;  105(5) 1502-1507
    PubMedGoogle Scholar
  • 128 Czaja A J, Strettell M DJ, Thomson L J et al.. Associations between alleles of the major histocompatibility complex and type 1 autoimmune hepatitis.  Hepatology. 1997;  25(2) 317-323
    PubMedGoogle Scholar
  • 129 Paavonen T, Andersson L C, Adlercreutz H. Sex hormone regulation of in vitro immune response. Estradiol enhances human B cell maturation via inhibition of suppressor T cells in pokeweed mitogen-stimulated cultures.  J Exp Med. 1981;  154(6) 1935-1945
    CrossrefPubMedGoogle Scholar
  • 130 Fox H S, Bond B L, Parslow T G. Estrogen regulates the IFN-γ promoter.  J Immunol. 1991;  146(12) 4362-4367
    PubMedGoogle Scholar
  • 131 Muller D, Chen M, Vikingsson A, Hildeman D, Pederson K. Oestrogen influences CD4 + T-lymphocyte activity in vivo and in vitro in β 2-microglobulin-deficient mice.  Immunology. 1995;  86(2) 162-167
    PubMedGoogle Scholar
  • 132 Gregorio G V, Portmann B, Reid F et al.. Autoimmune hepatitis in childhood: a 20-year experience.  Hepatology. 1997;  25(3) 541-547
    CrossrefPubMedGoogle Scholar
  • 133 Reber P M. Prolactin and immunomodulation.  Am J Med. 1993;  95(6) 637-644
    CrossrefPubMedGoogle Scholar
  • 134 Paavonen T. Hormonal regulation of immune responses.  Ann Med. 1994;  26(4) 255-258
    CrossrefPubMedGoogle Scholar
  • 135 Chao T C, Van Alten P J, Greager J A, Walter R J. Steroid sex hormones regulate the release of tumor necrosis factor by macrophages.  Cell Immunol. 1995;  160(1) 43-49
    CrossrefPubMedGoogle Scholar
  • 136 Kimura M, Tomita Y, Watanabe H, Sato S, Abo T. Androgen regulation of intra-and extra-thymic T cells and its effect on sex differences in the immune system.  Int J Androl. 1995;  18(3) 127-136
    CrossrefPubMedGoogle Scholar
  • 137 Nelson J L. Microchimerism: implications for autoimmune disease.  Lupus. 1999;  8(5) 370-374
    CrossrefPubMedGoogle Scholar
  • 138 Lambert N C, Evans P C, Hashizumi T L et al.. Cutting edge: persistent fetal microchimerism in T lymphocytes is associated with HLA-DQA1*0501: implications in autoimmunity.  J Immunol. 2000;  164(11) 5545-5548
    PubMedGoogle Scholar
  • 139 Tanaka A, Lindor K, Ansari A, Gershwin M E. Fetal microchimerisms in the mother: immunologic implications.  Liver Transpl. 2000;  6(2) 138-143
    PubMedGoogle Scholar
  • 140 Miozzo M, Selmi C, Gentilin B et al.. Preferential X chromosome loss but random inactivation characterize primary biliary cirrhosis.  Hepatology. 2007;  46(2) 456-462
    CrossrefPubMedGoogle Scholar
  • 141 Uribe M, Chavez-Tapia N C, Mendez-Sanchez N. Pregnancy and autoimmune hepatitis.  Ann Hepatol. 2006;  5(3) 187-189
    PubMedGoogle Scholar
  • 142 Willocx R G, Isselbacher K J. Chronic liver disease in young people. Clinical features and course in thirty-three patients.  Am J Med. 1961;  30 185-195
    CrossrefPubMedGoogle Scholar
  • 143 Read A E, Sherlock S, Harrison C V. Active “juvenile” cirrhosis considered as part of a systemic disease and the effect of corticosteroid therapy.  Gut. 1963;  4 378-393
    CrossrefPubMedGoogle Scholar
  • 144 Nagy S, Bush M C, Berkowitz R, Fishbein T M, Gomez-Lobo V. Pregnancy outcome in liver transplant recipients.  Obstet Gynecol. 2003;  102(1) 121-128
    CrossrefPubMedGoogle Scholar
  • 145 Werner M, Björnsson E, Prytz H et al.. Autoimmune hepatitis among fertile women: strategies during pregnancy and breastfeeding?.  Scand J Gastroenterol. 2007;  42(8) 986-991
    CrossrefPubMedGoogle Scholar
  • 146 Rosenkrantz J G, Githens J H, Cox S M, Kellum D L. Azathioprine (Imuran) and pregnancy.  Am J Obstet Gynecol. 1967;  97(3) 387-394
    PubMedGoogle Scholar
  • 147 Cook G C, Mulligan R, Sherlock S. Controlled prospective trial of corticosteroid therapy in active chronic hepatitis.  Q J Med. 1971;  40(158) 159-185
    PubMedGoogle Scholar
  • 148 Soloway R D, Summerskill W HJ, Baggenstoss A H et al.. Clinical, biochemical, and histological remission of severe chronic active liver disease: a controlled study of treatments and early prognosis.  Gastroenterology. 1972;  63(5) 820-833
    PubMedGoogle Scholar
  • 149 Murray-Lyon I M, Stern R B, Williams R. Controlled trial of prednisone and azathioprine in active chronic hepatitis.  Lancet. 1973;  1(7806) 735-737
    PubMedGoogle Scholar
  • 150 Koretz R L, Lewin K J, Higgins J, Fagen N D, Gitnick G L. Chronic active hepatitis. Who meets treatment criteria?.  Dig Dis Sci. 1980;  25(9) 695-699
    CrossrefPubMedGoogle Scholar
  • 151 Hodges J R, Millward-Sadler G H, Wright R. Chronic active hepatitis: the spectrum of disease.  Lancet. 1982;  1(8271) 550-552
    PubMedGoogle Scholar
  • 152 De Groote J, Fevery J, Lepoutre L. Long-term follow-up of chronic active hepatitis of moderate severity.  Gut. 1978;  19(6) 510-513
    PubMedGoogle Scholar
  • 153 Fevery J, Desmet V J, DeGroote J. Long-term follow-up and management of asymptomatic chronic active hepatitis. In: Cohen S, Soloway RD Chronic Active Liver Disease. New York; Churchill Livingstone 1983: 51-64
    Google Scholar
  • 154 Czaja A J, Taswell H F, Rakela J, Schimek C. Frequency of antibody to hepatitis C virus in asymptomatic HBsAg-negative chronic active hepatitis.  J Hepatol. 1992;  14(1) 88-93
    CrossrefPubMedGoogle Scholar
  • 155 Czaja A J, Magrin S, Fabiano C et al.. Hepatitis C virus infection as a determinant of behavior in type 1 autoimmune hepatitis.  Dig Dis Sci. 1995;  40(1) 33-40
    CrossrefPubMedGoogle Scholar
  • 156 Geall M G, Schoenfield L J, Summerskill W H. Classification and treatment of chronic active liver disease.  Gastroenterology. 1968;  55 724-729
    PubMedGoogle Scholar
  • 157 Kim W R, Flamm S L, Di Bisceglie A M, Bodenheimer Jr H C. Public Policy Committee of the American Association for the Study of Liver Disease . Serum activity of alanine aminotransferase (ALT) as an indicator of health and disease.  Hepatology. 2008;  47(4) 1363-1370
    CrossrefPubMedGoogle Scholar
  • 158 Lee T H, Kim W R, Benson J T, Therneau T M, Melton III L J. Serum aminotransferase activity and mortality risk in a United States community.  Hepatology. 2008;  47(3) 880-887
    CrossrefPubMedGoogle Scholar
  • 159 Baggenstoss A H, Soloway R D, Summerskill W HJ, Elveback L R, Schoenfield L J. Chronic active liver disease. The range of histologic lesions, their response to treatment, and evolution.  Hum Pathol. 1972;  3(2) 183-198
    CrossrefPubMedGoogle Scholar
  • 160 Schalm S W, Korman M G, Summerskill W HJ, Czaja A J, Baggenstoss A H. Severe chronic active liver disease. Prognostic significance of initial morphologic patterns.  Am J Dig Dis. 1977;  22(11) 973-980
    CrossrefPubMedGoogle Scholar
  • 161 Czaja A J, Ludwig J, Baggenstoss A H, Wolf A. Corticosteroid-treated chronic active hepatitis in remission: uncertain prognosis of chronic persistent hepatitis.  N Engl J Med. 1981;  304(1) 5-9
    PubMedGoogle Scholar
  • 162 Czaja A J, Carpenter H A. Progressive fibrosis during corticosteroid therapy of autoimmune hepatitis.  Hepatology. 2004;  39(6) 1631-1638
    CrossrefPubMedGoogle Scholar
  • 163 Czaja A J, Carpenter H A. Decreased fibrosis during corticosteroid therapy of autoimmune hepatitis.  J Hepatol. 2004;  40 646-652
    CrossrefPubMedGoogle Scholar
  • 164 Porta G, Gayotto L C, Alvarez F. Anti-liver-kidney microsome antibody-positive autoimmune hepatitis presenting as fulminant liver failure.  J Pediatr Gastroenterol Nutr. 1990;  11(1) 138-140
    PubMedGoogle Scholar
  • 165 Davis G L, Czaja A J, Baggenstoss A H, Taswell H F. Prognostic and therapeutic implications of extreme serum aminotransferase elevation in chronic active hepatitis.  Mayo Clin Proc. 1982;  57(5) 303-309
    PubMedGoogle Scholar
  • 166 Czaja A J, Rakela J, Ludwig J. Features reflective of early prognosis in corticosteroid-treated severe autoimmune chronic active hepatitis.  Gastroenterology. 1988;  95(2) 448-453
    PubMedGoogle Scholar
  • 167 Czaja A J. Corticosteroids or not in severe acute or fulminant autoimmune hepatitis: therapeutic brinksmanship and the point beyond salvation [editorial].  Liver Transpl. 2007;  13(7) 953-955
    CrossrefPubMedGoogle Scholar
  • 168 Montano-Loza A J, Carpenter H A, Czaja A J. Features associated with treatment failure in type 1 autoimmune hepatitis and predictive value of the model of end-stage liver disease.  Hepatology. 2007;  46(4) 1138-1145
    CrossrefPubMedGoogle Scholar
  • 169 Czaja A J. Current concepts in autoimmune hepatitis.  Ann Hepatol. 2005;  4(1) 6-24
    PubMedGoogle Scholar
  • 170 Czaja A J. Autoimmune hepatitis. Part B: diagnosis.  Expert Rev Gastroenterol Hepatol. 2007;  1(1) 129-143
    PubMedGoogle Scholar
  • 171 Nakamura K, Yoneda M, Yokohama S et al.. Efficacy of ursodeoxycholic acid in Japanese patients with type 1 autoimmune hepatitis.  J Gastroenterol Hepatol. 1998;  13(5) 490-495
    PubMedGoogle Scholar
  • 172 Fainboim L, Marcos Y, Pando M et al.. Chronic active autoimmune hepatitis in children. Strong association with a particular HLA-DR6 (DRB1*1301) haplotype.  Hum Immunol. 1994;  41(2) 146-150
    CrossrefPubMedGoogle Scholar
  • 173 Pando M, Larriba J, Fernandez G C et al.. Pediatric and adult forms of type I autoimmune hepatitis in Argentina: evidence for differential genetic predisposition.  Hepatology. 1999;  30(6) 1374-1380
    CrossrefPubMedGoogle Scholar
  • 174 Czaja A J, Souto E O, Bittencourt P L et al.. Clinical distinctions and pathogenic implications of type 1 autoimmune hepatitis in Brazil and the United States.  J Hepatol. 2002;  37(3) 302-308
    CrossrefPubMedGoogle Scholar
  • 175 Goldberg A C, Bittencourt P L, Oliveira L C et al.. Autoimmune hepatitis in Brazil: an overview.  Scand J Immunol. 2007;  66(2-3) 208-216
    CrossrefPubMedGoogle Scholar
  • 176 Hurlburt K J, McMahon B J, Deubner H, Hsu-Trawinski B, Williams J L, Kowdley K V. Prevalence of autoimmune liver disease in Alaska Natives.  Am J Gastroenterol. 2002;  97(9) 2402-2407
    CrossrefPubMedGoogle Scholar
  • 177 Scott J D, Garland N. Chronic liver disease in Aboriginal North Americans.  World J Gastroenterol. 2008;  14(29) 4607-4615
    CrossrefPubMedGoogle Scholar
  • 178 Minuk G Y, Liu S, Kaita K et al.. Autoimmune hepatitis in a North American Aboriginal/First Nations population.  Can J Gastroenterol. 2008;  22(10) 829-834
    PubMedGoogle Scholar
  • 179 Chung H V, Riley M, Ho J K et al.. Retrospective review of pediatric and adult autoimmune hepatitis in two quaternary care centres in British Columbia: increased prevalence seen in British Columbia's First Nations community.  Can J Gastroenterol. 2007;  21(9) 565-568
    PubMedGoogle Scholar
  • 180 Zolfino T, Heneghan M A, Norris S, Harrison P M, Portmann B C, McFarlane I G. Characteristics of autoimmune hepatitis in patients who are not of European Caucasoid ethnic origin.  Gut. 2002;  50(5) 713-717
    CrossrefPubMedGoogle Scholar
  • 181 D'Souza R, Sinnott P, Glynn M J, Sabin C A, Foster G R. An unusual form of autoimmune hepatitis in young Somalian men.  Liver Int. 2005;  25(2) 325-330
    CrossrefPubMedGoogle Scholar
  • 182 Czaja A J, Carpenter H A, Santrach P J, Moore S B. Genetic predispositions for the immunological features of chronic active hepatitis.  Hepatology. 1993;  18(4) 816-822
    PubMedGoogle Scholar
  • 183 Czaja A J, Santrach P J, Breanndan Moore S. Shared genetic risk factors in autoimmune liver disease.  Dig Dis Sci. 2001;  46(1) 140-147
    CrossrefPubMedGoogle Scholar
  • 184 Czaja A J, Donaldson P T. Genetic susceptibilities for immune expression and liver cell injury in autoimmune hepatitis.  Immunol Rev. 2000;  174 250-259
    CrossrefPubMedGoogle Scholar
  • 185 Czaja A J, Doherty D G, Donaldson P T. Genetic bases of autoimmune hepatitis.  Dig Dis Sci. 2002;  47(10) 2139-2150
    CrossrefPubMedGoogle Scholar
  • 186 Donaldson P T, Czaja A J. Genetic effects on susceptibility, clinical expression, and treatment outcome of type 1 autoimmune hepatitis.  Clin Liver Dis. 2002;  6(3) 707-725
    CrossrefPubMedGoogle Scholar
  • 187 Donaldson P T. Genetics in autoimmune hepatitis.  Semin Liver Dis. 2002;  22(4) 353-364
    Article in Thieme ConnectPubMedGoogle Scholar
  • 188 Vento S, Garofano T, Di Perri G, Dolci L, Concia E, Bassetti D. Identification of hepatitis A virus as a trigger for autoimmune chronic hepatitis type 1 in susceptible individuals.  Lancet. 1991;  337(8751) 1183-1187
    CrossrefPubMedGoogle Scholar
  • 189 Huppertz H I, Treichel U, Gassel A M, Jeschke R, Meyer zum Büschenfelde K-H. Autoimmune hepatitis following hepatitis A virus infection.  J Hepatol. 1995;  23(2) 204-208
    CrossrefPubMedGoogle Scholar
  • 190 Tanaka H, Tujioka H, Ueda H, Hamagami H, Kida Y, Ichinose M. Autoimmune hepatitis triggered by acute hepatitis A.  World J Gastroenterol. 2005;  11(38) 6069-6071
    PubMedGoogle Scholar
  • 191 Tabak F, Ozdemir F, Tabak O, Erer B, Tahan V, Ozaras R. Autoimmune hepatitis induced by the prolonged hepatitis A virus infection.  Ann Hepatol. 2008;  7(2) 177-179
    PubMedGoogle Scholar
  • 192 Fainboim L, Cañero Velasco M C, Marcos C Y et al.. Protracted, but not acute, hepatitis A virus infection is strongly associated with HLA-DRB*1301, a marker for pediatric autoimmune hepatitis.  Hepatology. 2001;  33(6) 1512-1517
    CrossrefPubMedGoogle Scholar
  • 193 Tapia-Conyer R, Santos J I, Cavalcanti A M et al.. Hepatitis A in Latin America: a changing epidemiologic pattern.  Am J Trop Med Hyg. 1999;  61(5) 825-829
    PubMedGoogle Scholar
  • 194 Cookson S, Constantini P K, Clare M et al.. Frequency and nature of cytokine gene polymorphisms in type 1 autoimmune hepatitis.  Hepatology. 1999;  30(4) 851-856
    CrossrefPubMedGoogle Scholar
  • 195 Czaja A J, Cookson S, Constantini P K, Clare M, Underhill J A, Donaldson P T. Cytokine polymorphisms associated with clinical features and treatment outcome in type 1 autoimmune hepatitis.  Gastroenterology. 1999;  117(3) 645-652
    PubMedGoogle Scholar
  • 196 Agarwal K, Czaja A J, Jones D E, Donaldson P T. Cytoxic T lymphocyte antigen-4 (CTLA-4) gene polymorphism and susceptibility to type 1 autoimmune hepatitis.  Hepatology. 2000;  31 49-53
    CrossrefPubMedGoogle Scholar
  • 197 Vogel A, Strassburg C P, Manns M P. Genetic association of vitamin D receptor polymorphisms with primary biliary cirrhosis and autoimmune hepatitis.  Hepatology. 2002;  35(1) 126-131
    CrossrefPubMedGoogle Scholar
  • 198 Hiraide A, Imazeki F, Yokosuka O et al.. Fas polymorphisms influence susceptibility to autoimmune hepatitis.  Am J Gastroenterol. 2005;  100(6) 1322-1329
    CrossrefPubMedGoogle Scholar
  • 199 Fan L, Tu X, Zhu Y et al.. Genetic association of vitamin D receptor polymorphisms with autoimmune hepatitis and primary biliary cirrhosis in the Chinese.  J Gastroenterol Hepatol. 2005;  20(2) 249-255
    CrossrefPubMedGoogle Scholar
  • 200 Agarwal K, Czaja A J, Donaldson P T. A functional Fas promoter polymorphism is associated with a severe phenotype in type 1 autoimmune hepatitis characterized by early development of cirrhosis.  Tissue Antigens. 2007;  69(3) 227-235
    CrossrefPubMedGoogle Scholar

Albert J CzajaM.D. 

Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine

200 First Street SW, Rochester, MN 55905

Email: czaja.albert@mayo.edu