Journal
WORLD JOURNAL OF GASTROENTEROLOGY
Volume 13, Issue 23, Pages 3232-3236Publisher
BAISHIDENG PUBLISHING GROUP INC
DOI: 10.3748/wjg.v13.i23.3232
Keywords
autoimmune hepatitis; tacrolimus; prednisone; azathioprine; mycophenolate mofetil; liver failure
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AIM: To determine the efficacy of tacrolimus on clinical status, histopathological, status and biochemical markers in patients with steroid refractory autoimmune hepatitis (AIH). METHODS: Retrospectively, clinical parameters, biochemistry and histology were obtained from patient records. RESULTS: Nine patients [8 females/1 male, median age 32 (range 16-64) years] were identified to have received tacrolimus for a median duration of 18 (12-37) mo. Before initiation of tacrolimus treatment the patients were maintained on a prednisolone dose of 20 mg daily (range 20-80 mg/d), which was tapered to 7.5 (5-12.5) mg/d (P = 0.004). Alanine aminotransferase and immunoglobulin-G concentrations decreased from 154 (100-475) to 47(22-61) U/L (P = 0.007), and from 1.6 (10-30.2) to 14.5 (8.4-20) g/L (P = 0.032), respectively. All patients showed improvement of the liver inflammatory activity, as determined by the Ishak score (R = 0.016), while the degree of fibrosis tended to decrease (P = 0.049). CONCLUSION: The use of low dose tacrolimus can lead to biochemical and histologic improvement of inflammation with no progression of the stage of fibrosis in patients with steroid refractory AIH. Low dose tacrolimus therapy also allows substantial, reduction of prednisone dose. (C) 2007 The WIG Press. All rights reserved.
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