{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T11:51:01Z","timestamp":1788609061892,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["No.ZYGD23031"],"award-info":[{"award-number":["No.ZYGD23031"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      Long\u2010term immunosuppression in autoimmune hepatitis (AIH) carries substantial side effects, making treatment withdrawal an important consideration after sustained biochemical remission. Whether biopsy\u2010guided withdrawal based on histological assessment reduces relapse compared with clinically guided withdrawal remains uncertain. We conducted a systematic review and meta\u2010analysis to compare relapse rates between these two strategies. This meta\u2010analysis followed PRISMA 2020. PubMed, Embase, Web of Science, Scopus and the Cochrane Library were searched from inception to identify studies reporting relapse after treatment withdrawal in AIH using biopsy\u2010guided or clinically guided strategies. Pooled relapse rates were estimated using random\u2010effects models of transformed proportions. Prespecified subgroup, sensitivity and meta\u2010regression analyses evaluated the impact of relapse definitions, histological stringency and follow\u2010up duration. Twelve studies (518 patients) were included. The pooled relapse rate after treatment withdrawal was 51.1%. Relapse rates were not significantly different between biopsy\u2010guided (48.3%) and clinically guided withdrawal (56.3%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.604). Studies defining relapse by transaminase elevation alone reported higher relapse rates than those incorporating IgG elevation. Within biopsy\u2010guided cohorts, stricter histological remission thresholds were associated with lower relapse rates and reduced heterogeneity.Relapse after treatment withdrawal in AIH remained common and did not differ significantly between biopsy\u2010guided and clinically guided strategies. In the context of existing guideline recommendations, current evidence does not clearly support routine prewithdrawal liver biopsy in all patients with sustained biochemical remission.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>PROSPERO registration number: 4202511295<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70642","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T03:06:01Z","timestamp":1776740761000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Relapse After Treatment Withdrawal in Autoimmune Hepatitis: Biopsy\u2010Guided Versus Clinically Guided Strategies\u2014A Meta\u2010Analysis"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4278-5112","authenticated-orcid":false,"given":"Yongqi","family":"Dong","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, and Laboratory of Gastrointestinal Cancer and Liver Disease West China Hospital, Sichuan University  Chengdu Sichuan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2058-7199","authenticated-orcid":false,"given":"Dan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, and Laboratory of Gastrointestinal Cancer and Liver Disease West China Hospital, Sichuan University  Chengdu Sichuan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5421-4117","authenticated-orcid":false,"given":"Leyu","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, and Laboratory of Gastrointestinal Cancer and Liver Disease West China Hospital, Sichuan University  Chengdu Sichuan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3821-9342","authenticated-orcid":false,"given":"Li","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, and Laboratory of Gastrointestinal Cancer and Liver Disease West China Hospital, Sichuan University  Chengdu Sichuan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6548-7089","authenticated-orcid":false,"given":"Yi","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, and Laboratory of Gastrointestinal Cancer and Liver Disease West China Hospital, Sichuan University  Chengdu Sichuan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1159\/000440756"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14051"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-021-10170-1"},{"issue":"12","key":"e_1_2_12_5_1","first-page":"1038","article-title":"Guidelines on the Diagnosis and Management of Autoimmune Hepatitis (2021)","volume":"60","author":"Chinese Society of Hepatology, Chinese Medical 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