J Pediatr 1984 Jun;104(6):839-44

Treatment of autoimmune chronic active hepatitis in childhood

Maggiore G, Bernard O, Hadchouel M, Hadchouel P, Odievre M, Alagille D

Abstract
Seventeen children with chronic active hepatitis and high serum titers of
smooth-muscle or liver-kidney microsomal antibodies were given prednisone and
azathioprine. Clinical and biochemical remission was obtained in all but two,
who died of progressive liver failure. Evaluations in 14 children after a mean
period of 22 months of treatment showed normal transaminase activity and
gammaglobulin levels in 12, and serum autoantibody titers of less than 1: 100 in
10; liver histologic findings showed absence of inflammation in seven children,
moderate portal or lobular inflammation in five, and minor features of
aggressivity in two. Cessation of therapy was then attempted in nine children.
Relapse occurred in all but one and could not be attributed to any previously
recorded biologic or histologic feature. After follow-up of 18 months to 7
years, all but two patients are still receiving maintenance therapy with
prednisone and azathioprine. Cirrhosis was present before treatment in 13
children and is now present in all but one. These results suggest that in most
children with autoimmune chronic active hepatitis, immunosuppressive therapy can
prevent further deterioration of liver function but must be pursued for several
years before discontinuation is attempted