Hepatitis autoinmune: conceptos actuales

Autores/as

  • Mónica P. Marino Sección Hepatología. Hospital C. Bonorino Udaondo.

DOI:

https://doi.org/10.52787/agl.v53i1.309

Palabras clave:

Hepatitis autoinmune, hepatitis de interfase, emperipolesis

Resumen

La hepatitis autoinmune es una patología poco frecuente que se caracteriza por presentar alteraciones bioquímicas e histológicas. Se conocen 2 subtipos: el tipo I afecta a niños y adultos y el tipo II afecta casi exclusivamente a los niños. Hasta el momento no existen criterios diagnósticos específicos y es considerada como una patología de exclusión, aunque existen ciertas alteraciones en el laboratorio y la histología relacionadas con esta entidad. Puede cursar en forma asintomática o sintomática y el tratamiento de elección es la inmunosupresión. El uso de métodos no invasivos como la elastografía puede ser útil en el monitoreo del seguimiento, tanto para evaluar el tratamiento como para prevenir complicaciones. En su evolución puede presentar fibrosis hepática avanzada, cirrosis, requerimiento de trasplante hepático o muerte por insuficiencia hepática. El objetivo de esta revisión es presentar las últimas publicaciones relacionadas a la hepatitis autoinmune.

Citas

-1. Pape S, et al Sistematicrewiew of response criteria and endpoints in autoimmune hepatitis by the International Autoimmune Hepatitis Group, J. Hepatol. 2022,76,841-849.

-2. Wang G, Tanaka A, Zhao H, Jia J, Ma X, Harada K, Wang FS, Wei L, Wang Q, Sun Y, Hong Y, Rao H, Efe C, Lau G, Payawal D, Gani R, Lindor K, Jafri W, Omata M, Sarin SK. The Asian Pacific Association for the Study of the Liver clinical practice guidance: the diagnosis and management of patients with autoimmune hepatitis. Hepatol Int. 2021 Apr;15(2):223-257. DOI: 10.1007/s12072-021-10170-1. Epub 2021 May 4. PMID: 33942203; PMCID: PMC8144150.

-3. Terziroli Beretta-Piccoli, B., Mieli-Vergani, G. &Vergani, D. Autoimmune Hepatitis: Serum Autoantibodies in Clinical Practice. ClinicRevAllergImmunol 63, 124-137 (2022). https://doi.org/10.1007/s12016-021-08888-9

-4. Mack, C.L., Adams, D., Assis, D.N., Kerkar, N., Manns, M.P., Mayo, M.J., Vierling, J.M., Alsawas, M., Murad, M.H. and Czaja, A.J. (2020), Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases. Hepatology, 72:671-722. https://doi.org/10.1002/hep.31065

-5. Mieli-Vergani G, Vergani D, Czaja AJ, Manns MP, Krawitt EL, Vierling JM, Lohse AW, Montano-Loza AJ. Autoimmune hepatitis. Nat Rev Dis Primers. 2018 Apr 12;4:18017. DOI: 10.1038/nrdp.2018.17. PMID: 29644994.

-6. Bhumi SA, Wu GY. Seronegative Autoimmune Hepatitis. J Clin Transl Hepatol. 2023 Apr 28;11(2):459-465. DOI: 10.14218/JCTH.2022.00235. Epub 2022 Sep 26. PMID: 36643052; PMCID: PMC9817061.

-7. Harrington, C, Krishnan, S, Mack, CL, Cravedi, P, Assis, DN, Levitsky, J. Noninvasive biomarkers for the diagnosis and management of autoimmune hepatitis. Hepatology. 2022;76: 1862-1879. https://doi.org/10.1002/hep.32591

-8. Ni XX, Lian M, Wu HM, Li XY, Sheng L, Bao H, Miao Q, Xiao X, Guo CJ, Li H, Ma X, Hua J. Evaluation of controlled attenuation parameter in assessing hepatic steatosis in patients with autoimmune liver diseases. World J Gastroenterol. 2021 Jan 7;27(1):80-91. DOI: 10.3748/wjg.v27.i1.80. PMID: 33505152; PMCID: PMC7789069.

-9. Gurung A, Assis DN, McCarty TR, Mitchell KA, Boyer JL, Jain D. Histologic features of autoimmune hepatitis: a critical appraisal. Hum Pathol. 2018;82:51-60. DOI: 10.1016/j.humpath.2018.07.014

-10. Lohse AW, Sebode M, Bhathal PS, Clouston AD, Dienes HP, Jain D, Gouw ASH, Guindi M, Kakar S, Kleiner DE, Krech T, Lackner C, Longerich T, Saxena R, Terracciano L, Washington K, Weidemann S, Hübscher SG, Tiniakos D. Consensus recommendations for histological criteria of autoimmune hepatitis from the International AIH Pathology Group: Results of a workshop on AIH histology hosted by the European Reference Network on Hepatological Diseases and the European Society of Pathology: Results of a workshop on AIH histology hosted by the European Reference Network on Hepatological Diseases and the European Society of Pathology. Liver Int. 2022 May;42(5):1058-1069. DOI: 10.1111/liv.15217. Epub 2022 Mar 12. PMID: 35230735.

-11. Hartl J, Ehlken H, Sebode M, Peiseler M, Krech T, Zenouzi R, von Felden J, Weiler-Normann C, Schramm C, Lohse AW. Usefulness of biochemical remission and transient elastography in monitoring disease course in autoimmune hepatitis. J Hepatol. 2018 Apr;68(4):754-763. DOI: 10.1016/j.jhep.2017.11.020. Epub 2017 Nov 24. PMID: 29180000.

-12. Hartl J, Denzer U, Ehlken H, Zenouzi R, Peiseler M, Sebode M, Hübener S, Pannicke N, Weiler-Normann C, Quaas A, Lohse AW, Schramm C. Transient elastography in autoimmune hepatitis: Timing determines the impact of inflammation and fibrosis. J Hepatol. 2016 Oct;65(4):769-775. DOI: 10.1016/j.jhep.2016.05.023. Epub 2016 May 26. PMID: 27238753.

-13. Yan YL, Xing X, Wang Y, Wang XZ, Wang Z, Yang L. Clinical utility of two-dimensional shear-wave elastography in monitoring disease course in autoimmune hepatitis-primary biliary cholangitis overlap syndrome. World J Gastroenterol. 2022 May 14;28(18):2021-2033. DOI: 10.3748/wjg.v28.i18.2021. PMID: 35664960; PMCID: PMC9150059.

-14. Efe, C, Kulkarni, AV, Terziroli Beretta-Piccoli, B, Magro, B, Stättermayer, A, Cengiz, M, et al. Liver injury after SARS-CoV-2 vaccination: features of immune-mediated hepatitis, role of corticosteroid therapy and outcome. Hepatology.2022;76:1576-1586. https://doi.org/10.1002/hep.32572

-15. Purnak T, Efe C, Kav T, Wahlin S, Ozaslan E. Treatment response and outcome with two different prednisolone regimens in autoimmune hepatitis. Dig Dis Sci 2017;62(10):2900-2907.

-16. Pape S, Gevers TJG, Belias M, Mustafajev IF, Vrolijk JM, van Hoek B, et al. Predniso(lo)ne dosage and chance of remission in patients with autoimmune hepatitis. Clin GastroenterolHepatol 2019;17(10):2068-2075.e2

-17. Beretta-Piccoli BT, Mieli-Vergani G, Vergani D. Autoimmune hepatitis: Standard treatment and systematic review of alternative treatments. World J Gastroenterol 2017;23(33):6030-6048

-18. Newman WG, Payne K, Tricker K, Roberts SA, Fargher E, Pushpakom S, et al. A pragmatic randomized controlled trial of thiopurine methyltransferase genotyping prior to aza- thioprine treatment: the TARGET study. Pharmacogenomics 2011;12(6):815-826.

-19. Rodríguez Y, Rojas M, Beltrán S, Polo F, Camacho-Domínguez L, Morales SD, Gershwin ME, Anaya JM. Autoimmune and autoinflammatory conditions after COVID-19 vaccination. New case reports and updated literature review. J Autoimmun. 2022 Oct;132:102898. DOI: 10.1016/j.jaut.2022.102898. Epub 2022 Aug 24. PMID: 36041291; PMCID: PMC9399140.

-20. European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; Clinical Practice Guideline Panel; Chair; EASL Governing Board representative; Panel members. EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis - 2021 update. J Hepatol. 2021 Sep;75(3):659-689. DOI: 10.1016/j.jhep.2021.05.025. Epub 2021 Jun 21. PMID: 34166721.

-21. Front. Immunol., 25 November 2022Sec. Autoimmune and Autoinflammatory Disorders: Autoimmune Disorders Volume 13-2022. https://doi.org/10.3389/fimmu.2022.1035073

-22. Schramm C, Herkel J, Beuers U et al. (2006) Pregnancy in autoimmune hepatitis: outcome and risk factors. Am J Gastroenterol 101:556-560. https://doi.org/10.1111/j.1572-0241.2006.00479.x

Descargas

Publicado

2023-03-30

Cómo citar

Marino, M. P. (2023). Hepatitis autoinmune: conceptos actuales. Acta Gastroenterológica Latinoamericana, 53(1), 28–37. https://doi.org/10.52787/agl.v53i1.309