Advanced histology and impaired liver regeneration are associated with disease severity in acute-onset autoimmune hepatitis

作者：Fujiwara Keiichi^*; Nakano Masayuki; Yasui Shin; Okitsu Koichiro; Yonemitsu Yutaka; Yokosuka Osamu

来源：Histopathology, 2011, 58(5): 693-704.

DOI：10.1111/j.1365-2559.2011.03790.x

• autoimmune hepatitis
• cytokeratin 7
• fulminant hepatitis
• liver regeneration
• severe hepatitis

Aims:
Some cases of acute-onset autoimmune hepatitis (AIH) develop into severe or fulminant forms showing massive/submassive hepatic necrosis, and have a poor prognosis. The pathological features of acute-onset AIH remain uncertain. Ductular (intermediate) hepatocytes after massive/submassive necrosis may serve as hepatic progenitor cells, and could be seen as cytokeratin 7 (CK7)-positive hepatocytes in immunohistochemistry. Therefore, the aim was to examine histological features to obtain a better evaluation of acute-onset AIH.
Methods:
The histological features of 27 clinically acute-onset AIH patients were examined by immunohistochemistry using CK7.
Results:
On staining for CK7, intermediate hepatocytes were less commonly present (P < 0.001) and ductular reactions were more commonly present (P < 0.001) in severe/fulminant patients than in non-severe ones. In severe and fulminant patients, intermediate hepatocytes and intralobular progenitor cells were more commonly present (P < 0.005 and P < 0.05, respectively) and ductular reactions were less commonly present (P = 0.007) in recovered patients than in dead ones. Severe patients had more clinically and histologically advanced disease.
Conclusions:
Immunohistochemical evalution using CK7 might be a useful tool for evaluating liver regeneration, and intermediate hepatocytes and progenitor cells might play an important role in liver regeneration after massive and submassive necrosis in acute-onset AIH.

• 出版日期2011-4