Internal Medicine

P1: SBT

0521779407-05 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:49

204 Autoimmune Hepatitis (AIH) Autonomic Dysfunction

■Liver transplantation (OLT) for treatment failures or end-stage dis-

ease

follow-up

During Therapy

■Regular monitoring of CBC, liver chemistry; gamma-globulin at end

of treatment

■Repeat liver biopsy to assess histologic response prior to cessation of

therapy; goal of therapy: normal biopsy or mild CAH; AST/ALT <2.5X

normal

■Relapse rate of 60–85% w/in 3 y, esp if histology still active at time of

treatment; rebound AST & gamma-globulin after cessation of ther-

apy predict histologic recurrence 75–90%; relapse requires retreat-

ment

complications and prognosis

■Cirrhosis:

➣40% progress to cirrhosis w/in 10 y despite therapy

➣Consider OLT for patients w/ liver failure (CTP score=7) or those

unresponsive to medical therapy

■Important risk factors for progression & need for OLT:

➣Male gender

➣Younger patients w/ type 2 AIH

➣Failure to achieve remission w/4yofimmunosuppression

➣Fulminant hepatic failure

■96% 5-y survival post-OLT

■AIH recurrence post-OLT (5–33%): HLA-DR3 (+) recipients of HLA-

DR3 (−) allografts; during or after prednisone taper or withdrawal

■Higher frequency of acute rejection post-OLT

■HCC: 7% w/ cirrhosis for=5y

Autonomic Dysfunction...............................

MICHAEL J. AMINOFF, MD, DSc

history & physical

■Postural dizziness

■Syncope (especially postural & postprandial)

■Hypo- or hyperhidrosis

■Urinary incontinence, urgency, frequency, hesitancy or retention