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New recommendations for histopathological diagnosis of autoimmune hepatitis

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Liver biopsy should remain the standard for diagnosing autoimmune hepatitis (AIH), according to consensus recommendations.

A group of 17 experts in the field of liver pathology met and modified a Delphi panel approach to establish consensus criteria for the histopathological diagnosis of AIH.

Their consensus recommendation is that liver biopsy should remain standard for diagnosing AIH. When there are no other histological features suggestive of another liver disease, and a predominantly portal lymphoplasmacytic hepatitis with more than mild interface activity and/or more than mild lobular hepatitis, AIH is considered the likely diagnosis.

In addition, AIH is likely when there is predominantly lobular hepatitis with or without centrilobular necroinflammation as well as at least 1 feature including portal lymphoplasmacytic hepatitis, interface hepatitis or portal-based fibrosis, in the absence of histological features suggestive of another liver disease.

The consensus determined that the following are not specific for AIH: emperipolesis and hepatocellular rosettes.

Lohse AW, Sebode M, Bhathal PS, et al. Consensus Recommendations for Histological Criteria of Autoimmune Hepatitis from the International AIH Pathology Group. Liver Int. 2022;doi: 10.1111/liv.15217. Epub ahead of print. PMID: 35230735.