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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 27, 2025; 17(12): 110966
Published online Dec 27, 2025. doi: 10.4254/wjh.v17.i12.110966
Published online Dec 27, 2025. doi: 10.4254/wjh.v17.i12.110966
Refractory autoimmune hepatitis in children: Considerations for assessment and management
Joseph Valamparampil, Patrick McKiernan, Liver Unit (including small bowel transplantation), Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham B4 6NH, United Kingdom
Rachel M Brown, Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
Author contributions: Brown RM and McKiernan P contributed to the critical review of the manuscript; Valamparampil J contributed to concept and design, writing, including literature search and review of evidence; Brown RM contributed to histopathological images. All authors have read and agreed to the submitted version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joseph Valamparampil, MD, Liver Unit (including small bowel trans
Received: June 20, 2025
Revised: August 13, 2025
Accepted: December 3, 2025
Published online: December 27, 2025
Processing time: 190 Days and 13.4 Hours
Revised: August 13, 2025
Accepted: December 3, 2025
Published online: December 27, 2025
Processing time: 190 Days and 13.4 Hours
Core Tip
Core Tip: Treatment of autoimmune hepatitis seeks to induce and maintain remission, prevent progression, and potentially reverse fibrosis. In the 10%-20% of children unresponsive to steroids and azathioprine, adherence to medication and diagnosis should be reassessed and mimicking diseases excluded. Mycophenolate mofetil is the preferred second-line agent. Further therapy should be individualized, with adjustments made only after 6-12 months.