[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-406693-105":59,"doc-detail-406693-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","refractory-autoimmune-hepatitis-in-children-considerations-for-assessment-and-management","Refractory autoimmune hepatitis in children - Considerations for assessment and management","","Refractory autoimmune hepatitis (AIH) in children refers to intolerance of or lack of response to standard immunosuppression, occurring in 10%-20% of pediatric cases. Slower-than-expected or absent induction of remission despite good compliance may be an early sign. Treatment refractoriness substantially increases the risk of liver transplantation or death from liver disease, making careful reassessment essential. Management centers on confirming compliance, re-evaluating diagnosis, excluding mimicking conditions, and accounting for extra-hepatic comorbidities and prior treatment history before choosing specialized-center regimens.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/refractory-autoimmune-hepatitis-in-children-considerations-for-assessment-and-management/406693/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/refractory-autoimmune-hepatitis-in-children-considerations-for-assessment-and-management/406693.png","ImageObject",300,407,{"name":92,"@type":93},"4398046744996","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"How is refractory autoimmune hepatitis in children defined, and how common is it?","Question",{"text":112,"@type":113},"Refractory AIH is defined as intolerance of or unresponsiveness to standard immunosuppression. It occurs in about 10%-20% of children with AIH.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What reassessments are prioritized before selecting a new regimen?",{"text":117,"@type":113},"First assess treatment compliance, then re-evaluate the diagnosis, consider alternative etiologies that mimic AIH features, and address extra-hepatic co-morbidities and prior adverse effects.",{"name":119,"@type":110,"acceptedAnswer":120},"Why does refractory AIH require specialized management and individualized therapy?",{"text":121,"@type":113},"Refractoriness is associated with a markedly higher risk of liver transplantation or death. Decisions should consider compliance with prior therapy, need for drug level monitoring, growth potential, formulations, administration route, and children’s and families’ preferences, with treatment determined and monitored only in specialized hepatology centers.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},406693,1790814789,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":66,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":133,"file_id":134,"file_url":135,"file_type":136,"file_size":137,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":138,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":36,"preview_page_count":4},4398046744996,"| W | J | H | World Journal of\u003Cbr>Hepatology |\n| --- | --- | --- | --- |\n\nSubmit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Hepatol 2025 December 27; 17(12): 110966  \nDOI: 10.4254/wjh.v17.i12.110966 ISSN 1948-5182 (online)  \nMINIREVIEWS  \nRefractory autoimmune hepatitis in children: Considerations for assessment and management  \nJoseph Valamparampil, Rachel M Brown, Patrick McKiernan  \nSpecialty type: Gastroenterology and hepatology  \nProvenance and peer review:  \nInvited article; Externally peer reviewed.  \nPeer-review model: Single blind  \nPeer-review report’s classification Scientific Quality: Grade A, Grade A, Grade B  \nNovelty: Grade A, Grade B, Grade B  \nCreativity or Innovation: Grade A, Grade B, Grade C  \nScientific Significance: Grade A, Grade A, Grade B  \nP-Reviewer: Kanthlal S, Chief, Full Professor, India; Zheng YY, Associate Professor, Associate Research Scientist, China  \nReceived: June 20, 2025  \nRevised: August 13, 2025  \nAccepted: December 3, 2025  \nPublished online: December 27, 2025  \nProcessing time: 189 Days and 12.9 Hours  \nJoseph Valamparampil, Patrick McKiernan, Liver Unit (including small bowel transplantation), Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham B4 6NH, United Kingdom  \nRachel M Brown, Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom  \nCorresponding author: Joseph Valamparampil, MD, Liver Unit (including small bowel transplantation), Birmingham Women’s and Children’s NHS Foundation Trust, Steelhouse Lane, Birmingham B4 6NH, [United Kingdom.](United Kingdom. joseph.valam@nhs.net)[ joseph.valam@nhs.net](United Kingdom. joseph.valam@nhs.net)  \nAbstract  \nRefractory autoimmune hepatitis (AIH) is defined as intolerance of or unresponsiveness to standard immunosuppression and occurs in 10%-20% of children with AIH. Lack of response or slower than expected response to induction of remission with steroids, despite good compliance, might be the first clue to refractory AIH. Refractoriness to treatment is associated with an 11.7 times higher risk for liver transplantation or death due to liver disease. The first and foremost consideration for the management is to assess compliance with treatment. It is then important tore-evaluate the diagnosis, assess alternative aetiologies which can mimic the clinical, serological, and histological features of AIH, and address the presence of extra-hepatic co-morbidities. It is important to consider the specific clinical situations, previous therapy, and prior adverse effects before deciding on the most appropriate treatment regimen in refractory AIH. Consideration also should be given to compliance with previous therapy, need for drug level monitoring, growth potential, available formulations, route of administration of medication, and children’s and families’ preferences before deciding on the therapy. Treatment should be decided and monitored only in specialized hepatology centers.  \nKey Words: Autoimmune hepatitis; Refractory; Remission; Treatment; Non-compliance  \n©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.  \n WJH  [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 27, 2025  Volume 17  Issue 12   \nValamparampil J et al. Management of paediatric refractory AIH  \nCore 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.  \nCitation: Valamparampil J, Brown RM, McKiernan P. Refractory autoimmune hepatitis in children: Considerations for assessment and management. World J Hepatol 2025; 17(12): 110966  \nURL: ","cbCaireAXL7AOcfy","https://ap.wps.com/l/cbCaireAXL7AOcfy","pdf",9372781,16,"English","# Core approach to refractory pediatric AIH\n## Definition, frequency, and clinical clues\n## Risks associated with refractoriness\n## Assessment before treatment changes\n## Individualized therapy planning in specialized centers\n# Treatment response and clinical significance\n## Treatment goals and remission outcomes\n## Heterogeneity of response","[{\"question\":\"How is refractory autoimmune hepatitis in children defined, and how common is it?\",\"answer\":\"Refractory AIH is defined as intolerance of or unresponsiveness to standard immunosuppression. It occurs in about 10%-20% of children with AIH.\"},{\"question\":\"What reassessments are prioritized before selecting a new regimen?\",\"answer\":\"First assess treatment compliance, then re-evaluate the diagnosis, consider alternative etiologies that mimic AIH features, and address extra-hepatic co-morbidities and prior adverse effects.\"},{\"question\":\"Why does refractory AIH require specialized management and individualized therapy?\",\"answer\":\"Refractoriness is associated with a markedly higher risk of liver transplantation or death. Decisions should consider compliance with prior therapy, need for drug level monitoring, growth potential, formulations, administration route, and children’s and families’ preferences, with treatment determined and monitored only in specialized hepatology centers.\"}]","Refractory autoimmune hepatitis in children - Considerations for assessment and management | PDF",1790567324]