Low-dose tacrolimus ameliorates liver inflammation and fibrosis in steroid refractory autoimmune hepatitis

Table 1 Grading of the inflammatory activity in chronic hepatitis according to Ishak et al (the maximum possible scoring is 18)

	Score
Portal inflammation
None	0
Mild, some or all portal areas	1
Moderate, some or all portal areas	2
Moderate/severe, all portal areas	3
Severe, all portal areas	4
Periportal or periseptal interface hepatitis (“piecemeal necrosis”)
Absent	0
Mild (focal, few portal areas)	1
Mild/moderate (focal, most portal areas)	2
Moderate (continuous around < 50% of tracts or septa)	3
Severe (continuous around > 50% of tracts or septa)	4
Focal parenchymal necrosis
Absent	0
1 focus or less per visual field of 100 × magnification	1
2-4 foci per 100 × magnification	2
5-10 foci per 100 × magnification	3
More than 10 foci per 100 × magnification	4
Confluent necrosis
Absent	0
Focal confluent necrosis	1
Zone 3 necrosis in some areas	2
Zone 3 necrosis in most areas	3
Zone 3 necrosis and occasional portal-central bridging	4
Zone 3 necrosis and multiple portal-central bridging	5
Panacinar or multiacinar necrosis	6

Table 2 Stages according to the METAVIR criteria (Bedossa et al)

Stage 0	No fibrosis
Stage 1	Mild fibrosis (portal/periportal fibrosis, no septa)
Stage 2	Moderate fibrosis (few septa)
Stage 3	Severe fibrosis (many septa, no cirrosis)
Stage 4	Cirrhosis

Table 3 Clinical characteristics of patients with AIH before tacrolimus treatment

Patient	Gender	Age	Prednisolone	Additional	HLA type	ALT	IgG	INR	Bilirubin	Albumin	Creatinine	Follow-up
No.		(yr)	dose	immonusupression		(U/L)	(g/L)		(μmol/L)	(g/L)	(μmol/L)	(mo)
1	F	64	20	MMF	N.A.	271	15	1.1	9	37.8	88	37
2	F	32	20	AZA	DR-3	156	29	1.6	30	28.0	71	20
3	F	49	20	MMF	DR-4,15	109	18	1.1	13	34.7	85	34
4	F	20	40	AZA	N.A.	102	12.3	0.9	13	43.0	55	18
5	F	17	20	AZA	DR-17, DQ2	475	30.2	1.0	146	39.1	59	13
6	M	16	80	AZA	DR-7,17	154	16	1.5	8	37.1	65	17
7	F	55	25	AZA	DR-4,13	100	17	1.1	58	37.1	49	12
8	F	49	20	AZA	DR-4,7	202	10	1.2	15	42.2	66	12
9	F	32	20	MMF	N.A.	126	16	1.1	6	33.3	68	36