Aggiornamento monografico
Epatiti autoimmuni attorno all’anno 2000
AUTOIMMUNE HEPATITIS IN THE YEAR 2000
ISABELLA GIUSEPPIN, STEFANO MARTELOSSI, LOREDANA LEPORE, GIULIANO TORRE, IRENE BRUNO E ALESSANDRO VENTURA
Clinica Pediatrica, Dipartimento di Scienze della Riproduzione e dello Sviluppo, Università di Trieste, IRCCS “Burlo Garofolo”
Ottobre 2001 - pagg. 499 -508
Abstract
Diagnosis of autoimmune hepatitis (AH) is based on: exclusion of viral genetic or tossic
etiology, presence of non-organ-specific antibodies (SMA, ANA or LKM1); increased G
immunoglobulin, typical histological features; response to immunosuppressive therapy, severity
and immunogenetic background. 21 cases, observed over 20 years, are reported.
They represent different types of AH: type 1, isolated (or lupoid, SMA positive); type 2,
LKM1 positive, often associated with autoimmune polyglandular syndromes; coeliac hepatitis
(or idyopatic hypertransaminasaemia); type 1 AH associated to coeliac disease; giantcell
hepatitis, Coombs test positive; AH following liver transplantation (de novo hepatitis);
autoimmune cholangitis associated with chronic inflammatory bowel disease.
Classificazione MeSH
Bibliografia
1. Maggiore G, Veber F, Bernard O, Hadchouel
M, Homberg JC, Alvarez F, Hadchouel
P. Autoimmune hepatitis associated
with anti-actin anti-bodies in children and
adolescents. J Pediatr Gastroenerol Nutr
1993;17:376-81.
2. Czaja AJ. Behavior and significance of autoantibodies in type I autoimmune hepatitis. J Hepatol 1999;30:394--401.
3. Maggiore G, Bernard O, Hadchouel P, Hadchouel M, Odievre M, Alagille D. Treatment of autoimmune chronic active hepatitis in childhood. J Pediatr 1984;104:839-44.
4. Johnson PJ, McFarlane IG, Williams R. Azatioprina for long term remission in autoimmune hepatitis. N Engl J Med 1995; 333:958-63.
5. Pando M, Larriba J, Fernandez GC. Pediatric and adult forms of type I autoimmune hepatitis in Argentina: evidence for differential genetic predisposition. Hepatology 1999; 30:1374-80.
6. Czaja AJ. Frequency and nature of variant syndromes of autoimmune liver disease. Hepatology 1998;23:360-5.
7. Obermayer, Straub P, Strassburg P, Manns M. Autoimmune Hepatitis. J Hepatol 2000;32(suppl 1):181-97.
8. Walker, Durie, Hammilton, Walker, Smith. Pediatric gastrointestinal disease 2. Edition. St. Louis: Mosby, 1996:1323-36.
9. Gregorio GV, Portman B, Reid F, Donaldson PT, Doherty DG, Mowat A, et al. Autoimmune hepatitis in childhood: A 20 year experience. Hepatology 1997;25,(3):541-7.
10. Maggiore G, Porta G, Bernard O, Hadchouel M, Alvarez F, Homberg JC, Alagille D. Autoimmune hepatitis with initial presentation as acute hepatic failure in young children. J Pediatr 1990;108:280-2.
11. Vento S, Garofano T, Di Perri G, Dolci L, Concia E. Identification of hepatitis A virus as trigger for autoimmune chronic hepatitis type I in susceptible individuals. Lancet 1991; 18:1183-7.
12. Manns MP, Obermayer Straub P. Viral induction of autoimmunity: mechanism and examples in hepatology. J Viral Hepatol 1997;4(supp. 2):42-7.
13. Triger DR. Raised antibody titres to measles and rubella viruses in chronic active hepatitis. Lancet 1972;1:665-7.
14. Homberg JC, Abuaf N, Bernard O, Islam S, Alvarez F. Chronic active hepatitis associated with anti-liver kidney microsome antibody type I:a second type of autoimmune hepatitis. Hepatology 1987;7(6):1333-9.
15. Lenzi M, Ballardini G, Fusconi M, Cassani F, Selleri L, Volta U, Zauli D. Type II autoimmune hepatitis and hepatitis C virus infection. Lancet 1995;335:258-9.
16. Toda G, Zeniya M, Watanabe F. Present status of autoimmune hepatitis in Japan correlating the characteristics with international criteria in an area with a high rate of HCV infection. Hepatology 1997;26:1207-12.
17. Debray D, Maggiore G, Girardet JP, Mallet E, Bernard O. Efficacy of Cyclosporin A in children with type II autoimmune hepatitis in children. J Pediatr 1999;135(1):111-4.
18. Schramm C, Kanzler S, Zum Buschenfelde KH, Galle PF. Autoimmune hepatitis in elderly. Am J Gastroenterol 2001;96(5):1587- 91.
19. Mowat A. Liver disorders in childhood. 3 edition. Oxford, 1995.
20. Czaja AJ, Manns M, McFarlane JG, Hoofnagle JH. Autoimmune Hepatitis: The investigational and clinical challenges. Hepatology 2000;31(5):1194-200.
21. Mugica F, Aranzadi MJ, Recasens M, Almagro F. Adult celiac disease and hipertransaminasemia. Rev Esp Enferm Dig 2000; 92(2):78-85.
22. Bardella MT, Vecchi M, Fraquelli M, Conte D, Del Ninno E, et al. Chronic unexplained hypertransaminasemia may be caused by occult celiac disease. Hepatology 1999;29(3):654-7.
23. Ramos Pla M, Julve Pardo R, Primo Vera J, Fernandez Chinchilla J. Hypertransaminasemia: indication for the diagnosis of celiac disease. Gastroenterology 1999;22(10):510-4.
24. Volta U, De Francaschi L, Lari F, Molinaro N, Zoli M, Bianchi FB. Coeliac disease hidden by criptogenic hypertransaminasemia Lancet 1998;4;352(9121):26-9.
25. Volta U, Granito A, De Franceschi L, Petrolini N, Bianchi FB. Anti tissue transglutaminase antibodies as predictors of silent coeliac disease in patients with hypertransaminasaemia of unknown origin. Dig Liver Dis 2001;33(5):420-5.
26. Clemente MG, Musu MP, Frau F, Brusco G, Sole G, Corazza GR, De Virgiliis S. Immune reaction against the cytoskeleton in coeliac disease. GUT 2000;47(4):520-6.
27. Volta U, De Franceschi L, Molinaro N, et al. Frequency and significance of anti-gliadin and anti-endomysial Antibodies in Autoimmune Hepatitis. Dig Dis Sci 1998;43(10): 2190-5.
28. SIGEP (Società Italiana di Gastroenterologia ed Epatologia Pediatrica). Maggiore G, Massei F, Ventura A, et al. Autoimmune liver disorders and coeliac disease in children: the SIGEP-CALD Study of the ESPGHAN. Geneva 9-12 May 2001.
29. Ventura A, Magazzù G, Greco L. Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. Gastroenterology 1999;117(2):297- 303.
30. Caiulo VA, Averbene C, Olmi S, et al. Celiac disease associated with chronic autoimmune hepatitis. Description of a case. Minerva Pediatrica 1993;45(12):511-3.
31. Classen JB. Cyclosporine induced autoimmunity in newborns prevented by early immunization. Autoimmunity 1998;27(3): 135-9.
32. Bernard O, Hadchouel M, Scotto J, Odievre M, Alagille D. Severe giant cell hepatitis with autoimmune hemolityc anemia in early childhood. J Pediatr 1981;99(5):704-11.
33. Melendez HV, Rela M, Baker AJ, Ball C, Portman B, Mieli-Vergani G, Heaton ND. Liver trasplant for giant cell hepatitis with autoimmune hemolitic anemia. Arch Dis Childhood 1997;77(3):249-51.
34. Phillips MJ, Blendis LM, Poucells Patterson J, Petric M. Syncitial giant cell hepatitis: sporadic hepatitis with distinctive pathological features a severe clinical course and paramyxoviral features. N Engl J Med 1991; 324(7):455-60.
35. Choulot JJ, Parent Y, Etcharryf Saint Martin J, Mensire A. Giant cell hepatitis and autoimmune hemolytic anemia: efficacy of splenectomy on hemolisis. Arch Pediatr 1996;3 (8):789-91.
36. Holm T, Kildahl, Andersen O, Valle PC. Primary sclerosing cholangitis with autoimmune hemolytic anemia and pulmonary infiltrations. Scand J Gastroenterol 1998;33(6): 669-72.
37. Arlett CM, Ramos R, Jiminez SA. Chimeric cells of maternal origin in juvanile idiopatic inflammatory myopathies. Childhood myositis Heterogeneity Collaborative G. Lancet 2000;356:2155-6.
38. Reed AM, Picornell YJ, Harwood A, Kredich DW. Chimerism in children with juvanile dermatomyositis. Lancet 2000;356;2156-7.
39. Nagamine K, Peterson P, Scott HS, Kudoh J, Minoshima S. Position cloning of the APECED gene. Nature Genetics 1997;17:393- 8.
40. Perniola R, Farloni A, Clemente MG, et al. Organ specific and non organ specific autoantibodies in children and young adults with autoimmune polyendocrinopaty-candidiasis- ectodermal dystrophy. Endocrinology 2000;143:497-503.
41. Ahonen P, Myllarniemi S, Sipila I, et al. Autoimmune polyendocrinopaty-candidiasisectodermal dystrophy (APECED) in series of 68 patients. N Engl J Med 1990; 322:1829-36.
42. Betterle C, Greggio NA, Volpato M. Autoimmune polyglandular syndrome type 1. J Clin Endocrinol Metabol 1998;83:1049-55.
43. Volgel A, Liermann H, Harmas A. Autoimmune regulator AIRE: evidence for genetic differences between autoimmune hepatitis and hepatitis as part of the autoimmune polyglandular syndrome type 1. Hepatology 2001;33(5):1047-52.
44. Clemente MG, Obermayer-Straub P, Meloni A, Strassburg CP, Arangino V, Tukey RH, De Virgiliis S, Manns MP. Cytochrome P450 1A2 is a hepatic autoantigen in autoimmune polyglandular syndrome type 1. J Clin Endocrinol Metabol 1997;82:1353-61.
45. Obermayer-Straub P, Perheentupa J, Braun S, Kayser A, Barut A, Loges S, Harms A, Dalekos G, Strassburg CP, Manns MP. Hepatic autoantigens in patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy. Gastroenterology 2001; 121(3):668-77.
46. Kerkar N, Hadzic N, Davies, Portman Donaldson. De novo autoimmune hepatitis after liver transplantation. Lancet 1998;351:409-13.
47. Gupta P, Hart J, Millis JM, Cronin D, Brady L. De novo hepatitis with autoimmune antibodies and atypical histology: a rare cause of late graft dysfunction after pediatric liver transplantation. Transplantation 2001; 71(5):664-8.
48. Conti F, Dousset B, Levillayer H, Gruska J. Autoantibodies after liver transplantation: a marker of allograft disease. J Hepatol 1997; 26(suppl.):150.
49. Clemente MG, De Virgiliis S, Musu MP, Ciccinarra E. Autoimmune manifestation in pediatric liver-transplantation recipients. ESPGHAN, Geneva, 9-12 May 2001.
50. Heneghan MA, Portmann BC, Norris SM, Williams R, Muiesan P, Rela M, Heaton ND, O’Grady JG. Graft dysfunction mimicking autoimmune hepatitis following liver transplantation in adults. Hepatology 2001; 34(3):464-70.
51. Hernandez HM, Kovarik P, Whitington PF, Alonso EM. Autoimmune hepatitis as a late complication of liver transplantation. J Pediatr Gastroenterol Nutr 2001;32:131-6.
52. Spada M, Bertani A, Sonzogni A, Petz W, Riva S, Torre G, Melzi ML, Alberti D, Colledan M, Segalin A, Lucianetti A, Gridelli B. A cause of late graft dysfunction after liver transplantation in children: de-novo autoimmune hepatitis. Transplant Proc 2001;33(1-2):1747- 8.
53. Pat BR, Xiao YX, Jimin L, Guo QH. Cyclosporin A induced autoimmune disease in mice. J Immunol 1993;151:39-50.
54. Hernandez Albujar A, Alvarez E, Salcedo M. Autoimmune mediated liver disease after liver transplantation. J Hepatol 1997;26(suppl.): 152.
55. Lohse AW, Obermayer-Straub P, Gerken G, et al. Development of cytochrome P450 2D6-specific LKM-autoantibodies following liver transplantation for Wilson’s disease possible association with steroid-resistant transplant rejection episode. J Hepatol 1999; 31:149-55.
56. Tan CK, Sian Ho JM. Concurrent de novo autoimmune hepatitis and recurrence of primary biliary cirrosis post-liver transplantation. Liver Transplant 2001;7(5):461-5.
57. Zauli D, Grassi A, Cassani F, Ballardini G, Bortolotti R, Muratori L. Autoimmune serology of primary sclerosing cholangitis. Dig Liver Dis 2001;33(4):391-2.
58. Boberg KM, Spurkland A, Rocca G, Egeland T, Saarinen S, Mitchell S, Broome U, Chapman R, Olerup O, Pares A, Rosina F, Schrumpf E. The HLA-DR3, DQ2 heterozygous genotype is associated with an accelerated progression of primary sclerosing cholangitis. Scand J Gastroenterol 2001;36(8):886- 90.
59. Angulo P, Pearce DH, Johnson CD, Henry JJ, La Russo NF, Petersen BT. Magnetic resonance cholangiography in patients with biliary disease: its role in primary sclerosing cholangitis. J Hepatol 2000;33(4):520- 7.
60. Wilschanski M, Chait P, Wade JA, Davis L, Corey M, St Louis P, Griffiths AM, Blendis LM, Moroz SP, Scully L, et al. Primary sclerosing cholangitis in 32 children: clinical, laboratory, and radiographic features, with survival analysis. Hepatology 1995;22(5):1415- 22.
61. Floreani A, Zancan L, Melis A, Baragiotta A, Chiaramonte M. Primary sclerosing cholangitis (PSC): clinical, laboratory and survival analysis in children and adults. Liver 1999;19(3):228-33.
62. Roozendaal C, Kallenberg CG. Anti-neutrophil cytoplasm autoantibodies (ANCA) in autoimmune liver disease. Hepatogastroenterol 1999;46,3034-40.
63. Terjung B, Spengler U, Sauerbruch T, Worman HJ. “Atypical” p-ANCA in IBD and hepatobiliary disorders react with a 50-kilodalton nuclear envelop protein of neutrophils and myeloid cell lines. Gastroenterology 2000;119,310-22.
64. Zauli D, Baffoni L, Cassani F, Fusconi M, Ballardini G, et al. Antineutrophil cytoplasmatic antibodies in primary sclerosing cholangitis, ulcerative colitis and autoimmune disease. Gastroenterology 1992;102:1088-95.
65. Bergquist A, Glaumann H, Persson B, Broome U. Risk factor and clinical presentation of hepatobiliary carcinoma in patients with primary sclerosing cholangitis: a case control study. Hepatology 1998;27(2):311-6.
66. Broome U, Lofberg R,Veress R, Eriksson LS. Primary sclerosing and ulcerative colitis: indicator of increased neoplastic potential. Hepatology 1995;22(5):1404-8.
67. Kumar D, Tandon RK. Use of ursodeoxycholic acid in liver diseases. J Gastroenterol Hepatol 2001;16(1):3-14.
68. Wadstrom T, Ljungh A, Willen R. Primary biliary cirrhosis and primary sclerosing cholangitis are of infectious origin! GUT 2001; 49(3):454.
2. Czaja AJ. Behavior and significance of autoantibodies in type I autoimmune hepatitis. J Hepatol 1999;30:394--401.
3. Maggiore G, Bernard O, Hadchouel P, Hadchouel M, Odievre M, Alagille D. Treatment of autoimmune chronic active hepatitis in childhood. J Pediatr 1984;104:839-44.
4. Johnson PJ, McFarlane IG, Williams R. Azatioprina for long term remission in autoimmune hepatitis. N Engl J Med 1995; 333:958-63.
5. Pando M, Larriba J, Fernandez GC. Pediatric and adult forms of type I autoimmune hepatitis in Argentina: evidence for differential genetic predisposition. Hepatology 1999; 30:1374-80.
6. Czaja AJ. Frequency and nature of variant syndromes of autoimmune liver disease. Hepatology 1998;23:360-5.
7. Obermayer, Straub P, Strassburg P, Manns M. Autoimmune Hepatitis. J Hepatol 2000;32(suppl 1):181-97.
8. Walker, Durie, Hammilton, Walker, Smith. Pediatric gastrointestinal disease 2. Edition. St. Louis: Mosby, 1996:1323-36.
9. Gregorio GV, Portman B, Reid F, Donaldson PT, Doherty DG, Mowat A, et al. Autoimmune hepatitis in childhood: A 20 year experience. Hepatology 1997;25,(3):541-7.
10. Maggiore G, Porta G, Bernard O, Hadchouel M, Alvarez F, Homberg JC, Alagille D. Autoimmune hepatitis with initial presentation as acute hepatic failure in young children. J Pediatr 1990;108:280-2.
11. Vento S, Garofano T, Di Perri G, Dolci L, Concia E. Identification of hepatitis A virus as trigger for autoimmune chronic hepatitis type I in susceptible individuals. Lancet 1991; 18:1183-7.
12. Manns MP, Obermayer Straub P. Viral induction of autoimmunity: mechanism and examples in hepatology. J Viral Hepatol 1997;4(supp. 2):42-7.
13. Triger DR. Raised antibody titres to measles and rubella viruses in chronic active hepatitis. Lancet 1972;1:665-7.
14. Homberg JC, Abuaf N, Bernard O, Islam S, Alvarez F. Chronic active hepatitis associated with anti-liver kidney microsome antibody type I:a second type of autoimmune hepatitis. Hepatology 1987;7(6):1333-9.
15. Lenzi M, Ballardini G, Fusconi M, Cassani F, Selleri L, Volta U, Zauli D. Type II autoimmune hepatitis and hepatitis C virus infection. Lancet 1995;335:258-9.
16. Toda G, Zeniya M, Watanabe F. Present status of autoimmune hepatitis in Japan correlating the characteristics with international criteria in an area with a high rate of HCV infection. Hepatology 1997;26:1207-12.
17. Debray D, Maggiore G, Girardet JP, Mallet E, Bernard O. Efficacy of Cyclosporin A in children with type II autoimmune hepatitis in children. J Pediatr 1999;135(1):111-4.
18. Schramm C, Kanzler S, Zum Buschenfelde KH, Galle PF. Autoimmune hepatitis in elderly. Am J Gastroenterol 2001;96(5):1587- 91.
19. Mowat A. Liver disorders in childhood. 3 edition. Oxford, 1995.
20. Czaja AJ, Manns M, McFarlane JG, Hoofnagle JH. Autoimmune Hepatitis: The investigational and clinical challenges. Hepatology 2000;31(5):1194-200.
21. Mugica F, Aranzadi MJ, Recasens M, Almagro F. Adult celiac disease and hipertransaminasemia. Rev Esp Enferm Dig 2000; 92(2):78-85.
22. Bardella MT, Vecchi M, Fraquelli M, Conte D, Del Ninno E, et al. Chronic unexplained hypertransaminasemia may be caused by occult celiac disease. Hepatology 1999;29(3):654-7.
23. Ramos Pla M, Julve Pardo R, Primo Vera J, Fernandez Chinchilla J. Hypertransaminasemia: indication for the diagnosis of celiac disease. Gastroenterology 1999;22(10):510-4.
24. Volta U, De Francaschi L, Lari F, Molinaro N, Zoli M, Bianchi FB. Coeliac disease hidden by criptogenic hypertransaminasemia Lancet 1998;4;352(9121):26-9.
25. Volta U, Granito A, De Franceschi L, Petrolini N, Bianchi FB. Anti tissue transglutaminase antibodies as predictors of silent coeliac disease in patients with hypertransaminasaemia of unknown origin. Dig Liver Dis 2001;33(5):420-5.
26. Clemente MG, Musu MP, Frau F, Brusco G, Sole G, Corazza GR, De Virgiliis S. Immune reaction against the cytoskeleton in coeliac disease. GUT 2000;47(4):520-6.
27. Volta U, De Franceschi L, Molinaro N, et al. Frequency and significance of anti-gliadin and anti-endomysial Antibodies in Autoimmune Hepatitis. Dig Dis Sci 1998;43(10): 2190-5.
28. SIGEP (Società Italiana di Gastroenterologia ed Epatologia Pediatrica). Maggiore G, Massei F, Ventura A, et al. Autoimmune liver disorders and coeliac disease in children: the SIGEP-CALD Study of the ESPGHAN. Geneva 9-12 May 2001.
29. Ventura A, Magazzù G, Greco L. Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. Gastroenterology 1999;117(2):297- 303.
30. Caiulo VA, Averbene C, Olmi S, et al. Celiac disease associated with chronic autoimmune hepatitis. Description of a case. Minerva Pediatrica 1993;45(12):511-3.
31. Classen JB. Cyclosporine induced autoimmunity in newborns prevented by early immunization. Autoimmunity 1998;27(3): 135-9.
32. Bernard O, Hadchouel M, Scotto J, Odievre M, Alagille D. Severe giant cell hepatitis with autoimmune hemolityc anemia in early childhood. J Pediatr 1981;99(5):704-11.
33. Melendez HV, Rela M, Baker AJ, Ball C, Portman B, Mieli-Vergani G, Heaton ND. Liver trasplant for giant cell hepatitis with autoimmune hemolitic anemia. Arch Dis Childhood 1997;77(3):249-51.
34. Phillips MJ, Blendis LM, Poucells Patterson J, Petric M. Syncitial giant cell hepatitis: sporadic hepatitis with distinctive pathological features a severe clinical course and paramyxoviral features. N Engl J Med 1991; 324(7):455-60.
35. Choulot JJ, Parent Y, Etcharryf Saint Martin J, Mensire A. Giant cell hepatitis and autoimmune hemolytic anemia: efficacy of splenectomy on hemolisis. Arch Pediatr 1996;3 (8):789-91.
36. Holm T, Kildahl, Andersen O, Valle PC. Primary sclerosing cholangitis with autoimmune hemolytic anemia and pulmonary infiltrations. Scand J Gastroenterol 1998;33(6): 669-72.
37. Arlett CM, Ramos R, Jiminez SA. Chimeric cells of maternal origin in juvanile idiopatic inflammatory myopathies. Childhood myositis Heterogeneity Collaborative G. Lancet 2000;356:2155-6.
38. Reed AM, Picornell YJ, Harwood A, Kredich DW. Chimerism in children with juvanile dermatomyositis. Lancet 2000;356;2156-7.
39. Nagamine K, Peterson P, Scott HS, Kudoh J, Minoshima S. Position cloning of the APECED gene. Nature Genetics 1997;17:393- 8.
40. Perniola R, Farloni A, Clemente MG, et al. Organ specific and non organ specific autoantibodies in children and young adults with autoimmune polyendocrinopaty-candidiasis- ectodermal dystrophy. Endocrinology 2000;143:497-503.
41. Ahonen P, Myllarniemi S, Sipila I, et al. Autoimmune polyendocrinopaty-candidiasisectodermal dystrophy (APECED) in series of 68 patients. N Engl J Med 1990; 322:1829-36.
42. Betterle C, Greggio NA, Volpato M. Autoimmune polyglandular syndrome type 1. J Clin Endocrinol Metabol 1998;83:1049-55.
43. Volgel A, Liermann H, Harmas A. Autoimmune regulator AIRE: evidence for genetic differences between autoimmune hepatitis and hepatitis as part of the autoimmune polyglandular syndrome type 1. Hepatology 2001;33(5):1047-52.
44. Clemente MG, Obermayer-Straub P, Meloni A, Strassburg CP, Arangino V, Tukey RH, De Virgiliis S, Manns MP. Cytochrome P450 1A2 is a hepatic autoantigen in autoimmune polyglandular syndrome type 1. J Clin Endocrinol Metabol 1997;82:1353-61.
45. Obermayer-Straub P, Perheentupa J, Braun S, Kayser A, Barut A, Loges S, Harms A, Dalekos G, Strassburg CP, Manns MP. Hepatic autoantigens in patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy. Gastroenterology 2001; 121(3):668-77.
46. Kerkar N, Hadzic N, Davies, Portman Donaldson. De novo autoimmune hepatitis after liver transplantation. Lancet 1998;351:409-13.
47. Gupta P, Hart J, Millis JM, Cronin D, Brady L. De novo hepatitis with autoimmune antibodies and atypical histology: a rare cause of late graft dysfunction after pediatric liver transplantation. Transplantation 2001; 71(5):664-8.
48. Conti F, Dousset B, Levillayer H, Gruska J. Autoantibodies after liver transplantation: a marker of allograft disease. J Hepatol 1997; 26(suppl.):150.
49. Clemente MG, De Virgiliis S, Musu MP, Ciccinarra E. Autoimmune manifestation in pediatric liver-transplantation recipients. ESPGHAN, Geneva, 9-12 May 2001.
50. Heneghan MA, Portmann BC, Norris SM, Williams R, Muiesan P, Rela M, Heaton ND, O’Grady JG. Graft dysfunction mimicking autoimmune hepatitis following liver transplantation in adults. Hepatology 2001; 34(3):464-70.
51. Hernandez HM, Kovarik P, Whitington PF, Alonso EM. Autoimmune hepatitis as a late complication of liver transplantation. J Pediatr Gastroenterol Nutr 2001;32:131-6.
52. Spada M, Bertani A, Sonzogni A, Petz W, Riva S, Torre G, Melzi ML, Alberti D, Colledan M, Segalin A, Lucianetti A, Gridelli B. A cause of late graft dysfunction after liver transplantation in children: de-novo autoimmune hepatitis. Transplant Proc 2001;33(1-2):1747- 8.
53. Pat BR, Xiao YX, Jimin L, Guo QH. Cyclosporin A induced autoimmune disease in mice. J Immunol 1993;151:39-50.
54. Hernandez Albujar A, Alvarez E, Salcedo M. Autoimmune mediated liver disease after liver transplantation. J Hepatol 1997;26(suppl.): 152.
55. Lohse AW, Obermayer-Straub P, Gerken G, et al. Development of cytochrome P450 2D6-specific LKM-autoantibodies following liver transplantation for Wilson’s disease possible association with steroid-resistant transplant rejection episode. J Hepatol 1999; 31:149-55.
56. Tan CK, Sian Ho JM. Concurrent de novo autoimmune hepatitis and recurrence of primary biliary cirrosis post-liver transplantation. Liver Transplant 2001;7(5):461-5.
57. Zauli D, Grassi A, Cassani F, Ballardini G, Bortolotti R, Muratori L. Autoimmune serology of primary sclerosing cholangitis. Dig Liver Dis 2001;33(4):391-2.
58. Boberg KM, Spurkland A, Rocca G, Egeland T, Saarinen S, Mitchell S, Broome U, Chapman R, Olerup O, Pares A, Rosina F, Schrumpf E. The HLA-DR3, DQ2 heterozygous genotype is associated with an accelerated progression of primary sclerosing cholangitis. Scand J Gastroenterol 2001;36(8):886- 90.
59. Angulo P, Pearce DH, Johnson CD, Henry JJ, La Russo NF, Petersen BT. Magnetic resonance cholangiography in patients with biliary disease: its role in primary sclerosing cholangitis. J Hepatol 2000;33(4):520- 7.
60. Wilschanski M, Chait P, Wade JA, Davis L, Corey M, St Louis P, Griffiths AM, Blendis LM, Moroz SP, Scully L, et al. Primary sclerosing cholangitis in 32 children: clinical, laboratory, and radiographic features, with survival analysis. Hepatology 1995;22(5):1415- 22.
61. Floreani A, Zancan L, Melis A, Baragiotta A, Chiaramonte M. Primary sclerosing cholangitis (PSC): clinical, laboratory and survival analysis in children and adults. Liver 1999;19(3):228-33.
62. Roozendaal C, Kallenberg CG. Anti-neutrophil cytoplasm autoantibodies (ANCA) in autoimmune liver disease. Hepatogastroenterol 1999;46,3034-40.
63. Terjung B, Spengler U, Sauerbruch T, Worman HJ. “Atypical” p-ANCA in IBD and hepatobiliary disorders react with a 50-kilodalton nuclear envelop protein of neutrophils and myeloid cell lines. Gastroenterology 2000;119,310-22.
64. Zauli D, Baffoni L, Cassani F, Fusconi M, Ballardini G, et al. Antineutrophil cytoplasmatic antibodies in primary sclerosing cholangitis, ulcerative colitis and autoimmune disease. Gastroenterology 1992;102:1088-95.
65. Bergquist A, Glaumann H, Persson B, Broome U. Risk factor and clinical presentation of hepatobiliary carcinoma in patients with primary sclerosing cholangitis: a case control study. Hepatology 1998;27(2):311-6.
66. Broome U, Lofberg R,Veress R, Eriksson LS. Primary sclerosing and ulcerative colitis: indicator of increased neoplastic potential. Hepatology 1995;22(5):1404-8.
67. Kumar D, Tandon RK. Use of ursodeoxycholic acid in liver diseases. J Gastroenterol Hepatol 2001;16(1):3-14.
68. Wadstrom T, Ljungh A, Willen R. Primary biliary cirrhosis and primary sclerosing cholangitis are of infectious origin! GUT 2001; 49(3):454.