Treatment of Acute Liver Failure in Acute Severe Autoimmune Hepatitis (AS-AIH)

Acute liver failure arising in the setting of acute severe autoimmune hepatitis (AS-AIH) is a time-sensitive clinical emergency. Identifying the autoimmune aetiology early is essential, as it directly determines the first-line treatment pathway.

Clinical Scenario

This protocol addresses patients presenting with acute liver failure in the context of acute severe autoimmune hepatitis (AS-AIH) — an aggressive inflammatory hepatic injury that can deteriorate rapidly and requires prompt, targeted intervention.

First-Line Treatment Approach

For patients with AS-AIH, the evidence-based approach centres on intravenous corticosteroid therapy administered promptly after diagnosis. The complete regimen — including agent selection, dosing framework, monitoring parameters, and escalation criteria — is detailed in the full structured protocol. Full sequencing, clinical decision points, and response assessment criteria are available below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.14309/ajg.0000000000002340

In patients presenting with AS-AIH, we suggest the use of IV corticosteroids.

For those with AS-AIH without ALF, glucocorticoid therapy (prednisone or prednisolone alone, 0.5-1 mg/kg or a total of 60 mg daily in adults) can be beneficial without an increased risk of adverse outcome such as infection.

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