Case - Autoimmune Hepatitis

Autoimmune hepatitis is a rare condition which is decreasing in incidence

Approximately 20% of patients with hepatitis C will present with an acute hepatitic illness characterised by the presence of jaundice

Antibiotics are a well recognised cause of drug-induced liver disease

Wilsons disease is a disorder or iron homeostasis

Approximately 40% of heavy alcohol consumers will develop alcoholic liver diseas

The mortality rate from a liver biopsy is less than 0.001%

The elevated levels of immunoglobulin seen in patients with autoimmune disease consist almost entirely of autoantibodies

IgM elevation is a characteristic feature of autoimmune hepatitis

The peak age for the diagnosis of AIH is 45-55

Anti-LKM antibodies are seen in hepatitis C infections as well as AIH

The combination of anti-double-stranded DNA antibodies and anti-nuclear antibodies is diagnostic of SLE.

2. The ANA pattern characteristic of PBC is multiple nuclear dots and rim-like staining

It is difficult to distinguish between hepatitis B and AIH on liver biopsy

Complement levels are typically elevated in SLE

SLE never affects the liver

Tetracycline is a well recognised trigger for AIH

Minocycline is a well recognised trigger for AIH

Hepatitis C virus is a well recognised trigger for AIH

CMV is a well recognised trigger for AIH

Environmental pollution can trigger autoimmune disease

IgA levels provide an accurate measure for activity of alcoholic liver disease

IgM levels provide an accurate measure for activity of PBC

Changes in autoantibody level are a more accurate measure of AIH activity than IgG levels

Specific reduction in the level of IgG through plasmapheresis has been shown to be an effective treatment in AIH

IgG level is a more valuable marker for disease activity than alkaline phosphatase level in AIH

Tacrolimus is used as first line treatment for AIH in approximately 20% of patients in the UK

Patients who are unable to, tolerate azathioprine because of side effects are usually able to take MMF despite the common structure of the drugs

The vast majority of patient taking prednisolone will develop osteoporosis.

Prednisolone therapy should always be stopped after 6 months in patients with AIH

Liver toxicity precludes the use of cyclosporine for the treatment of AIH

Graft versus host disease (GVHD) is a common occurrence following liver transplantation

Chronic GVHD can mimic PBC

Heart and lung transplantation is more complex than lung transplantation alone

First year survival after liver transplantation is typically 65-70%

Breast cancer 7 years previously would be an absolute contra-indication to lung transplantation

It is normal to commence immuno-suppressive treatment in the 24 hours before a transplant operation

Patients undergoing liver transplantation typically require greater levels of immuno-suppression than those undergoing bone marrow transplantation

Matching for blood group is important for renal transplant but not liver transplant success

Pre-transplant blood transfusion reduces the risk of rejection in renal transplantation

The combination of tacrolimus and cyclosporine is particularly effective at preventing organ

Mouse monoclonal antibodies are safe to give to humans

Most monoclonal antibodies used for the treatment of humans are humanised mouse antibodies

OKT3 (anti-CD3) is used in approximately 25% of liver transplant patients

The characteristic infection seen in patients receiving infliximab (anti-TNF) is herpes simplex

Rituximab (anti-CD20) is particularly effective for the treatment of T-cell lymphomas

Skin malignancy is a common problem in post-transplant patients

Post-Transplant Lymphoproliferative Disorder (PTLD) is a form of lymphoma driven by CMV infection

CMV is only rarely seen post-tranplant

Cyclosporine but not tacrolimus can cause renal impairment

Neurological effects are a common problem with azathioprine treatment