Question Title: autoimmune hepitits

Dear Scarlet:

You ask some important questions about autoimmune hepatitis especially, in terms, of how this disease will affect your 8 year old daughter. Obviously, you are very concerned about her future. My sense is that she responded to the combination of prednisone and imuran, that she has continued to do well on imuran alone and that the plan is to “wean” her off imuran. You wonder what are her chances of having a relapse or to develop cirrhosis or to need a liver transplant.

Well as you can imagine, these are very difficult questions and I am sure your own physicians are having difficulty coming up with answers that are fully satisfactory to you. I am going to have the same difficulty but I’ll try to provide you with some information that is helpful to you.

First of all, not all autoimmune disease is the same. Autoimmune hepatitis comes in several flavors and some are worse than others. In addition, your daughter’s future depends to some degree upon how bad her initial disease was, what her liver biopsy showed, and how readily she responded to therapy. I don’t have the answers to all these questions.

I will say that most patients with autoimmune hepatitis will relapse at some point in their lives especially when prednisone and imuran are tapered. Many of these patients will eventually develop cirrhosis and some will need liver transplants. However, some patients will have prolonged remissions and in some cases these remissions are indefinite. In patients who have sustained remissions after medication is stopped, the development of cirrhosis is unusual.

If your daughter has the most common form of autoimmune hepatitis (type 1), if she has relatively mild disease on biopsy with a good response to prednisone and imuran and if she is able to maintain her remission as these drugs are stopped, there is a good chance that she can do well for years to decades to come. We are all going to hope that this is the case.

I suspect these answers are less definite than you would like. I can imagine, how, upsetting it is for you, to have a daughter who has this somewhat unusual diagnosis of which you might not previously have heard. However, it is the case that how your daughter does in the next months and years will give your doctors and you a feel for how she well she will do down the road. I would also note to you, that as physicians we are learning a lot and your daughter should benefit as we get better at treating this condition.

I hope the information is helpful to you. As always, if you have additional questions or more information, feel free to post the material back to MEDHELP or you are always welcome to contact us directly at Henry Ford at (313) 556-8865.

This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.