Matta B, Cabello R, Rabinovitz M, Minervini M, Malik S. Post-infantile giant cell hepatitis: A single center’s experience over 25 years. World J Hepatol 2019; 11(12): 752-760 [PMID: 31966907 DOI: 10.4254/wjh.v11.i12.752]
Corresponding Author of This Article
Shahid Malik, MD, Department of Medicine, University of Pittsburgh, Division of Gastroenterology, Hepatology and Nutrition, 3471 5th Ave 916 Lillian Kaufman Building, Pittsburgh, PA 15213, United States. maliks@upmc.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Dec 27, 2019; 11(12): 752-760 Published online Dec 27, 2019. doi: 10.4254/wjh.v11.i12.752
Post-infantile giant cell hepatitis: A single center’s experience over 25 years
Bassem Matta, Ricardo Cabello, Mordechai Rabinovitz, Marta Minervini, Shahid Malik
Bassem Matta, Mordechai Rabinovitz, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, PA 15213, United States
Ricardo Cabello, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States
Marta Minervini, Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15213, United States
Shahid Malik, Department of Medicine, University of Pittsburgh, Division of Gastroenterology Hepatology and Nutrition, Pittsburgh, PA 15213, United States
Author contributions: Matta B and Malik SM designed the research study, obtained and analyzed data and wrote manuscript; Cabello R, Rabinovitz M and Minervini M contributed with data interpretation and critical review of manuscript for intellectual content; All authors have read and approve the final manuscript.
Institutional review board statement: This study was reviewed and approved by the University of Pittsburgh Medical Center Institution Review Board PRO12030073.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: There were no conflict of interests to disclose.
Data sharing statement: All data requests should be submitted to the corresponding author for consideration. Access to anonymized data may be granted following review.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shahid Malik, MD, Department of Medicine, University of Pittsburgh, Division of Gastroenterology, Hepatology and Nutrition, 3471 5th Ave 916 Lillian Kaufman Building, Pittsburgh, PA 15213, United States. maliks@upmc.edu
Telephone: +1-412-6474932 Fax: +1-412-6479268
Received: May 15, 2019 Peer-review started: May 17, 2019 First decision: July 4, 2019 Revised: September 9, 2019 Accepted: October 18, 2019 Article in press: October 18, 2019 Published online: December 27, 2019 Processing time: 225 Days and 11.2 Hours
Abstract
BACKGROUND
Giant cell hepatitis in the adult population remains very poorly defined with only 100 case reports published in the literature over the last three decades.
AIM
To present our center’s experience in an attempt to learn about the predisposing factors, outcomes and efficacy of proposed therapeutic interventions for giant cell hepatitis.
METHODS
A retrospective chart review was conducted through the electronic records of the University of Pittsburgh Medical Center. We queried 36726 liver biopsy reports from January 1, 1991 to December 6, 2016. Our search yielded 50 patients who were identified as carrying a definite diagnosis of post-infantile giant cell hepatitis (PIGCH) by pathology. The data collected included demographic information, laboratory data (liver function tests, autoimmune markers) and transplant status. In order to better analyze patient characteristics and outcomes, subjects were separated into a non-transplant (native) liver group and a post-liver transplant (allograft) group.
RESULTS
The incidence of PIGCH was approximately 0.14% of all biopsies queried in the 25-year period. The mean age was 48 years with 66% females. Liver function tests were classified as 38.2% cholestatic, 35.3% hepatocellular and 26.5% mixed. Autoimmune hepatitis was found to be the most prevalent predisposing factor leading to PIGCH constituting 32% of cases. Management consisted mainly of immunosuppression, viral targeted therapy, supportive care and in six cases liver transplantations.
CONCLUSION
The diagnosis of PIGCH remains clinically challenging and requires a high index of suspicion as well as a thorough history, physical examination, serological workup and liver biopsy. Treatment of the underlying cause can result in clinical stability in a large number of cases.
Core tip: Post-infantile giant cell hepatitis is a rare disorder and very poorly defined in the literature. Our study aimed to present our center’s experience in an attempt to shed more light about the predisposing factors, outcomes and efficacy of proposed therapeutic interventions for post-infantile giant cell hepatitis.
