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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 8, 2016; 8(28): 1157-1168
Published online Oct 8, 2016. doi: 10.4254/wjh.v8.i28.1157
Cirrhosis and autoimmune liver disease: Current understanding
Rodrigo Liberal, Charlotte R Grant
Rodrigo Liberal, Charlotte R Grant, Institute of Liver Studies, King’s College London School of Medicine at King’s College Hospital, London SE 9RS, United Kingdom
Author contributions: Liberal R and Grant CR contributed to paper design, literature search, drafting and editing of the manuscript; both authors approved the final version of the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
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/
Correspondence to: Dr. Rodrigo Liberal, Institute of Liver Studies, King’s College London School of Medicine at King’s College Hospital, Denmark Hill, London SE5 9RS, United Kingdom. rodrigo.liberal@kcl.ac.uk
Telephone: +44-2032-993397 Fax: +44-2032-993760
Received: March 3, 2016
Peer-review started: March 7, 2016
First decision: April 15, 2016
Revised: July 22, 2016
Accepted: August 6, 2016
Article in press: August 8, 2016
Published online: October 8, 2016
Processing time: 209 Days and 10 Hours
Abstract

Primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and autoimmune hepatitis (AIH) constitute the classic autoimmune liver diseases (AILDs). While AIH target the hepatocytes, in PBC and PSC the targets of the autoimmune attack are the biliary epithelial cells. Persistent liver injury, associated with chronic AILD, leads to un-resolving inflammation, cell proliferation and the deposition of extracellular matrix proteins by hepatic stellate cells and portal myofibroblasts. Liver cirrhosis, and the resultant loss of normal liver function, inevitably ensues. Patients with cirrhosis have higher risks or morbidity and mortality, and that in the decompensated phase, complications of portal hypertension and/or liver dysfunction lead to rapid deterioration. Accurate diagnosis and monitoring of cirrhosis is, therefore of upmost importance. Liver biopsy is currently the gold standard technique, but highly promising non-invasive methodology is under development. Liver transplantation (LT) is an effective therapeutic option for the management of end-stage liver disease secondary to AIH, PBC and PSC. LT is indicated for AILD patients who have progressed to end-stage chronic liver disease or developed intractable symptoms or hepatic malignancy; in addition, LT may also be indicated for patients presenting with acute liver disease due to AIH who do not respond to steroids.

Keywords: Hepatic fibrosis; Cirrhosis; Myofibroblasts; Primary biliary cirrhosis; Primary sclerosing cholangitis; Autoimmune hepatitis; Liver transplantation

Core tip: In chronic liver disease, including autoimmune liver diseases, perpetual liver injury leads to persistent inflammation, cell proliferation and the deposition of extracellular matrix proteins. If left untreated, this process eventually leads to the development of liver cirrhosis, characterised by the presence of fibrosis and nodular regeneration. Liver biopsy is currently the gold standard technique, but highly promising non-invasive methodology is under development.