Guidelines for therapy of autoimmune liver disease.

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Semin Liver Dis.

2007 May 27.

Guidelines for therapy of autoimmune

liver disease.

Ishibashi H, Komori A, Shimoda S, Gershwin ME.

Clinical Research Center,

Nagasaki Medical

Center, Nagasaki,

Japan

The principle of therapy for chronic inflammatory

liver diseases is the removal of causal agents. For

autoimmune liver diseases, however, total removal of causal agents and immune

cells is impossible. Therefore, autoimmune liver

diseases are presently treated by suppression of the immune response. Autoimmune hepatitis is characteristically responsive to

corticosteroids, often used in combination with azathioprine

to obtain a steroid-sparing effect. For primary

biliary cirrhosis, ursodeoxycholic acid is safe and

is the first choice for treatment. Treatment of this

autoimmune liver disease should also address various symptoms and complications

arising from any associated autoimmune diseases, particularly cholestasis and cirrhosis-related complications. For primary sclerosing cholangitis

there are no established immunomodulatory therapies,

but medical, endoscopic, and surgical treatments are

applicable to this disease. Liver transplantation

becomes indicated during the eventual end stages of each of these

immune-mediated liver diseases.

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