Transient Elastography in Autoimmune Hepatitis
Condition: Liver Cirrhosis
MeSH terms: Hepatitis; Liver Cirrhosis; Hepatitis, Autoimmune; Fibrosis
Study type: Interventional

Summary: 
      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
    

Detailed description: 
      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.
    

Intervention name(s): Transient elastography (TE); Liver biopsy
Intervention type(s): Device; Other
Intervention description(s): TE and minilaparoscopic guided liver biopsy were performed by physicians blinded to the results the other within a period of less than 3 months.; Minilaparoscopic guided liver biopsy was performed within a period of 3 months of Transient Elastography
Intervention model: Single Group Assignment
Masking: Single (Investigator)
Primary purpose: Diagnostic
Keywords: Transient elastography; mini-laparoscopy; liver biopsy; liver cirrhosis; autoimmune hepatitis