Furthermore, because AIH can recur after liver transplantation, we hypothesized that those patients with histological features of autoimmunity would be more likely to develop chronic hepatitis in their native livers if they recovered

from ALF, or to develop recurrent allograft hepatitis after liver transplantation. AI-ALF, autoimmune acute liver failure; AIH, autoimmune hepatitis; AMA, antimitochondrial antibodies; ANA, antinuclear antibodies; anti-LKM, anti-liver/kidney microsome; anti-SLA, anti-soluble liver antigen; anti-tTG, anti-tissue transglutaminase; APAP, acetaminophen; ASMA, anti-smooth muscle antibody; HBV, hepatitis B virus; IAIHG, International Autoimmune Enzalutamide molecular weight Hepatitis Group; INR,

international normalized ratio; MHN, massive hepatic necrosis; OLT, orthotopic liver transplantation; SDC, simplified diagnostic criteria for AIH. The study population was BMN 673 cell line enrolled in the ALF Study Group Registry between 1998 and 2008. Entry criteria included ALF (coagulopathy [international normalized ratio INR ≥ 1.5] and hepatic encephalopathy within 26 weeks of the onset of illness, in a patient without previously recognized liver disease).15 Study subjects were chosen from a total registry of 1100 patients on the basis of having an indeterminate evaluation for the etiology of ALF, defined as: (1) no serologic evidence of acute viral hepatitis, (2) no evidence of ischemic liver injury (acute Budd-Chiari syndrome or “shock liver,”), and (3) no evidence of drug-induced hepatotoxicity (history of APAP overdose or recent prescription drug or over-the-counter herbal exposure). Patients with suspected acute Wilson disease or liver failure related to malignancy or pregnancy were also excluded. These criteria identified a subpopulation of 204 patients with ALF of indeterminate

etiology, some of whom had detectable autoantibodies on admission and were thereby suspected of having AIH. However, because autoantibodies are often nonspecific, they were considered nondiagnostic for the purposes of this study. Attempts were made to recover liver samples from each of 204 patients meeting the inclusion criteria above. Records indicated that 61 subjects Endonuclease had neither liver biopsies nor explant pathology available. Of the 143 potential samples, tissue was recovered from 79 (55%) for histological evaluation. Adequate liver tissue for analysis was recovered in 72 cases (50% of total); specimens from seven subjects were inadequate for diagnosis due to small size. Forty-six samples were obtained from liver explants and 26 from transjugular liver biopsies. Clinical and serological characteristics of the 204 total patients and the subset of 72 with liver tissue available were similar, suggesting that the latter was a balanced subset of the former (data not shown).