Transient Elastography in Autoimmune Hepatitis
Transient Elastography in Autoimmune Hepatitis
Recent, research has focused on the evaluation of non-invasive methods for the assessment of
 liver fibrosis in patients with chronic liver disease. Among these methods, transient
 elastography is the most promising. The method has been investigated mainly in patients with
 viral hepatitis. Several studies have shown, that the optimal cut-off value of TE for
 detection of liver cirrhosis by transient elastography is highly dependent on the aetiology
 of the underlying liver disease. Only a few studies have evaluated the value of transient
 elastography for patients with autoimmune liver disease and here primarily patients with PBC
 and PSC. For patients with autoimmune hepatitis the data is limited. We prospectively
 investigated the diagnostic accuracy of TE in autoimmune hepatitis compared to liver
 histology with and without inclusion of the macroscopic appearance using mini-laparoscopy
The aim of the current study was to assess the diagnostic performance of transient
 elastography for the determination of cirrhosis in patients with autoimmune hepatitis
 compared to the diagnosis of cirrhosis made on Laparoscopic guided liver biopsy. Patients
 referred for liver biopsy and transient elastography with a clinical diagnosis of AIH
 followed in the liver clinic of the Department of Gastroenterology at the UKE were
 prospectively included in the study.

 Inclusion criteria were as follows: Confirmed diagnosis of AIH based on the diagnostic
 criteria revised by the International Autoimmune Hepatitis Group 2008 (20): 1. liver related
 autoantibodies, 2. hypergammaglobulinaemia, 3.typical histological findings and 4. absence of
 viral markers. Exclusion criteria were morbid obesity (BMI > 40), ascites, ileus or subileus,
 peritonitis, pregnancy, extrahepatic cholestasis and a severe inflammatory flare of AIH.

 Blood liver tests including gamma-globulines, IgG, IgM, liver related autoantibodies (ANA,
 AMA, LKM, SMA, SLA) and viral markers (HBsAg, Anti HBs, Anti HBc, Anti HCV, Anti HAV) were
 performed before LB.

 Each patient underwent abdominal ultrasound to exclude extrahepatic cholestasis prior to TE
 and minilaparoscopic liver biopsy. TE and minilaparoscopy were performed by physicians
 blinded to the results the other within a period of less than 3 months.
Inclusion Criteria:

 Confirmed diagnosis of AIH based on the diagnostic criteria revised by the International
 Autoimmune Hepatitis Group 2008 (20):

 1. liver related autoantibodies,

 2. hypergammaglobulinaemia,

 3. typical histological findings and

 4. absence of viral markers.

 Exclusion Criteria:

 -  morbid obesity (BMI > 40),

 -  ascites, ileus or subileus,

 -  peritonitis,

 -  pregnancy,

 -  extrahepatic cholestasis and

 -  a severe inflammatory flare of AIH.