Treatment of Autoimmune Hepatitis in AIH-Related Decompensated Cirrhosis with Signs of Disease Activity
This protocol covers patients with autoimmune hepatitis who have developed decompensated cirrhosis while still showing active inflammation — a high-stakes combination that requires a structured, evidence-based response.
Clinical Scenario
The patient has AIH-related decompensated cirrhosis with ongoing disease activity, evidenced by elevated aminotransferase levels and/or a modified hepatic activity index (mHAI) of 4 or greater. The presence of active hepatic inflammation on a background of decompensated cirrhosis defines this distinct and clinically urgent sub-population.
Treatment Approach — partial overview
Corticosteroid therapy is considered in this setting alongside concurrent evaluation for liver transplantation at a specialist transplant centre. The full protocol specifies the complete regimen, decision criteria, and sequencing.
Full regimen available via the link below ↓
Treatment Goal
The target is a biochemical response, defined as normalisation of aminotransferase levels.
References
DOI: 10.1016/j.jhep.2025.03.017
- Corticosteroid treatment should be considered in patients with AIH-related decompensated cirrhosis with signs of disease activity (elevated aminotransferase levels and/or mHAI > −4) (LoE 4, strong recommendation, strong consensus).
- Patients with AIH-related decompensated cirrhosis should be evaluated for LT (LoE 2, strong recommendation, strong consensus).
- Sharma et al.350 found that 30% of patients with mild ascites (n = 38) and 4% of those with gross ascites (n = 24) achieved biochemical response defined as normalisation of aminotransferase levels.
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