Skip to main content
SpringerLink
Log in
Book cover

Liver Immunology pp 45–53Cite as

Diagnostic Liver Immunology

  • Chapter
  • First Online:

  • 2462 Accesses

Abstract

The vast majority of liver diseases involve, at least in part, an immunologic reaction either as a primary cause of liver injury or in response to an infectious agent. Primary biliary cirrhosis (PBC) and nonalcoholic steatohepatitis (NASH) are representative of the former while viral hepatitis B and C are typical of the latter. Historically, the diagnosis of a liver disease was based primarily on histology and in large part the types and locations of inflammatory cells within the liver parenchyma. This remains the case for alcoholic liver disease and the now epidemic fatty liver disease. However, increasingly specific liver disease diagnoses are made based upon specific immune responses signified by the presence of specific antibodies and other serologic findings. Currently, genetic tests in liver immunology are limited to HLA class II alleles in autoimmune hepatitis and hereditary hemochromatosis, the latter a result of variants in the HLA class I-like HFE gene resulting in dysregulation of the antimicrobial peptide hepcidin and subsequent iron overload. However, as our understanding of the genetic basis of liver diseases progresses, the use of individualized genetics will likely become increasing important in diagnosing many liver diseases and personalizing their treatments. In this chapter, we will review the common liver diseases with an immunologic basis with an emphasis on the diagnostic tools in current use (Table 4.1).

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Lee TH, Kim WR, Benson JT, Therneau TM, Melton 3rd LJ. Serum aminotransferase activity and mortality risk in a United States community. Hepatology. 2008;47(3):880–7. doi:10.1002/hep.22090. PubMed PMID: 18302294.

    Article  PubMed  Google Scholar 

  2. Kim HC, Nam CM, Jee SH, Han KH, Oh DK, Suh I. Normal serum aminotransferase concentration and risk of mortality from liver diseases: prospective cohort study. BMJ. 2004;328(7446):983. doi:10.1136/bmj.38050.593634.63. PubMed PMID: 15028636; PubMed Central PMCID: PMC404493.

    Article  PubMed  CAS  Google Scholar 

  3. Lemon SM, Binn LN. Serum neutralizing antibody response to hepatitis A virus. J Infect Dis. 1983;148(6):1033–9. PubMed PMID: 6317766.

    Article  PubMed  CAS  Google Scholar 

  4. Kao HW, Ashcavai M, Redeker AG. The persistence of hepatitis A IgM antibody after acute clinical hepatitis A. Hepatology. 1984;4(5):933–6. PubMed PMID: 6090293.

    Article  PubMed  CAS  Google Scholar 

  5. Liaw YF, Yang CY, Chu CM, Huang MJ. Appearance and persistence of hepatitis A IgM antibody in acute clinical hepatitis A observed in an outbreak. Infection. 1986;14(4):156–8. PubMed PMID: 3759243.

    Article  PubMed  CAS  Google Scholar 

  6. Centers for Disease Control and Prevention. Positive test results for acute hepatitis A virus infection among persons with no recent history of acute hepatitis—United States, 2002–2004. MMWR Morb Mortal Wkly Rep. 2005;54(18):453–6. PubMed PMID: 15889006.

    Google Scholar 

  7. Tassopoulos NC, Papatheodoridis GV, Kalantzakis Y, Tzala E, Delladetsima JK, Koutelou MG, et al. Differential diagnosis of acute HBsAg positive hepatitis using IgM anti-HBc by a rapid, fully automated microparticle enzyme immunoassay. J Hepatol. 1997;26(1):14–9. PubMed PMID: 9148005.

    Article  PubMed  CAS  Google Scholar 

  8. Gupta S, Govindarajan S, Fong TL, Redeker AG. Spontaneous reactivation in chronic hepatitis B: patterns and natural history. J Clin Gastroenterol. 1990;12(5):562–8. PubMed PMID: 2230000.

    Article  PubMed  CAS  Google Scholar 

  9. Said ZN. An overview of occult hepatitis B virus infection. World J Gastroenterol. 2011;17(15):1927–38. doi:10.3748/wjg.v17.i15.1927. PubMed PMID: 21528070; PubMed Central PMCID: PMC3082745.

    Article  PubMed  Google Scholar 

  10. Hollinger FB. Hepatitis B, virus infection and transfusion medicine: science and the occult. Transfusion. 2008;48(5):1001–26. doi:10.1111/j.1537-2995.2008.01701.x. PubMed PMID: 18454738.

    Article  PubMed  CAS  Google Scholar 

  11. Koo YX, Tay M, Teh YE, Teng D, Tan DS, Tan IB, et al. Risk of hepatitis B virus (HBV) reactivation in hepatitis B surface antigen negative/hepatitis B core antibody positive patients receiving rituximab-containing combination chemotherapy without routine antiviral prophylaxis. Ann Hematol. 2011;90(10):1219–23. doi:10.1007/s00277-011-1241-0. PubMed PMID: 21520001.

    Article  PubMed  CAS  Google Scholar 

  12. Evens AM, Jovanovic BD, Su YC, Raisch DW, Ganger D, Belknap SM, et al. Rituximab-associated hepatitis B virus (HBV) reactivation in lymphoproliferative diseases: meta-analysis and examination of FDA safety reports. Ann Oncol. 2011;22(5):1170–80. doi:10.1093/annonc/mdq583. PubMed PMID: 21115603; PubMed Central PMCID: PMC3082161.

    Article  PubMed  CAS  Google Scholar 

  13. Matsue K, Kimura S, Takanashi Y, Iwama K, Fujiwara H, Yamakura M, et al. Reactivation of hepatitis B virus after rituximab-containing treatment in patients with CD20-positive B-cell lymphoma. Cancer. 2010;116(20):4769–76. doi:10.1002/cncr.25253. PubMed PMID: 20597091.

    Article  PubMed  Google Scholar 

  14. Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology. 2009;50(3):661–2. doi:10.1002/hep.23190. PubMed PMID: 19714720.

    Article  PubMed  Google Scholar 

  15. European Association for the Study of the L. EASL Clinical Practice Guidelines: management of chronic hepatitis B. J Hepatol. 2009;50(2):227–42. doi:10.1016/j.jhep.2008.10.001. PubMed PMID: 19054588.

    Article  Google Scholar 

  16. Chaves SS, Fischer G, Groeger J, Patel PR, Thompson ND, Teshale EH, et al. Persistence of long-term immunity to hepatitis B among adolescents immunized at birth. Vaccine. 2012;30(9):1644–9. doi:10.1016/j.vaccine.2011.12.106. PubMed PMID: 22245310.

    Article  PubMed  Google Scholar 

  17. Smith BD, Morgan RL, Beckett GA, Falck-Ytter Y, Holtzman D, Teo CG, et al. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945–1965. MMWR Recomm Rep. 2012;61(RR-4):1–32. PubMed PMID: 22895429.

    PubMed  Google Scholar 

  18. Barrera JM, Bruguera M, Ercilla MG, Sanchez-Tapias JM, Gil MP, Costa J, et al. Incidence of non-A, non-B hepatitis after screening blood donors for antibodies to hepatitis C virus and surrogate markers. Ann Intern Med. 1991;115(8):596–600. PubMed PMID: 1909848.

    Article  PubMed  CAS  Google Scholar 

  19. Ghany MG, Strader DB, Thomas DL, Seeff LB, American Association for the Study of Liver D. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009;49(4):1335–74.

    Article  PubMed  CAS  Google Scholar 

  20. Pascarella S, Negro F. Hepatitis D virus: an update. Liver Int. 2011;31(1):7–21. doi:10.1111/j.1478-3231.2010.02320.x. PubMed PMID: 20880077.

    Article  PubMed  CAS  Google Scholar 

  21. Kamar N, Bendall R, Legrand-Abravanel F, Xia NS, Ijaz S, Izopet J, et al. Hepatitis E. Lancet. 2012;379(9835):2477–88. doi:10.1016/S0140-6736(11)61849-7. PubMed PMID: 22549046.

    Article  PubMed  Google Scholar 

  22. Kuniholm MH, Purcell RH, McQuillan GM, Engle RE, Wasley A, Nelson KE. Epidemiology of hepatitis E virus in the United States: results from the Third National Health and Nutrition Examination Survey, 1988–1994. J Infect Dis. 2009;200(1):48–56. doi:10.1086/599319. PubMed PMID: 19473098; PubMed Central PMCID: PMC2762746.

    Article  PubMed  Google Scholar 

  23. Faramawi MF, Johnson E, Chen S, Pannala PR. The incidence of hepatitis E virus infection in the general population of the USA. Epidemiol Infect. 2011;139(8):1145–50. doi:10.1017/S0950268810002177. PubMed PMID: 20854712.

    Article  PubMed  CAS  Google Scholar 

  24. Bizzaro N, Covini G, Rosina F, Muratori P, Tonutti E, Villalta D, et al. Overcoming a “probable” diagnosis in antimitochondrial antibody negative primary biliary cirrhosis: study of 100 sera and review of the literature. Clin Rev Allergy Immunol. 2012;42(3):288–97. doi:10.1007/s12016-010-8234-y. PubMed PMID: 21188646.

    Article  PubMed  CAS  Google Scholar 

  25. Kikuchi K, Lian ZX, Kimura Y, Selmi C, Yang GX, Gordon SC, et al. Genetic polymorphisms of toll-like receptor 9 influence the immune response to CpG and contribute to hyper-IgM in primary biliary cirrhosis. J Autoimmun. 2005;24(4):347–52. doi:10.1016/j.jaut.2005.03.002. PubMed PMID: 15878652.

    Article  PubMed  CAS  Google Scholar 

  26. Kikuchi K, Lian ZX, Yang GX, Ansari AA, Ikehara S, Kaplan M, et al. Bacterial CpG induces hyper-IgM production in CD27(+) memory B cells in primary biliary cirrhosis. Gastroenterology. 2005;128(2):304–12. PubMed PMID: 15685542.

    Article  PubMed  CAS  Google Scholar 

  27. Lleo A, Liao J, Invernizzi P, Zhao M, Bernuzzi F, Ma L, et al. Immunoglobulin M levels inversely correlate with CD40 ligand promoter methylation in patients with primary biliary cirrhosis. Hepatology. 2012;55(1):153–60. doi:10.1002/hep.24630. PubMed PMID: 21898485; PubMed Central PMCID: PMC3245335.

    Article  PubMed  CAS  Google Scholar 

  28. Hov JR, Boberg KM, Karlsen TH. Autoantibodies in primary sclerosing cholangitis. World J Gastroenterol. 2008;14(24):3781–91. PubMed PMID: 18609700; PubMed Central PMCID: PMC2721433.

    Article  PubMed  CAS  Google Scholar 

  29. Terjung B, Spengler U, Sauerbruch T, Worman HJ. “Atypical p-ANCA” in IBD and hepatobiliary disorders react with a 50-kilodalton nuclear envelope protein of neutrophils and myeloid cell lines. Gastroenterology. 2000;119(2):310–22. PubMed PMID: 10930366.

    Article  PubMed  CAS  Google Scholar 

  30. Terjung B, Sohne J, Lechtenberg B, Gottwein J, Muennich M, Herzog V, et al. p-ANCAs in autoimmune liver disorders recognise human beta-tubulin isotype 5 and cross-react with microbial protein FtsZ. Gut. 2010;59(6):808–16. doi:10.1136/gut.2008.157818. PubMed PMID: 19951907.

    Article  PubMed  CAS  Google Scholar 

  31. European Association for the Study of the L. EASL Clinical Practice Guidelines: management of cholestatic liver diseases. J Hepatol. 2009;51(2):237–67. doi:10.1016/j.jhep.2009.04.009. PubMed PMID: 19501929.

    Article  Google Scholar 

  32. Chapman R, Fevery J, Kalloo A, Nagorney DM, Boberg KM, Shneider B, et al. Diagnosis and management of primary sclerosing cholangitis. Hepatology. 2010;51(2):660–78. doi:10.1002/hep.23294. PubMed PMID: 20101749.

    Article  PubMed  CAS  Google Scholar 

  33. Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999;31(5):929–38. PubMed PMID: 10580593.

    Article  PubMed  CAS  Google Scholar 

  34. Johnson PJ, McFarlane IG. Meeting report: International Autoimmune Hepatitis Group. Hepatology. 1993;18(4):998–1005. PubMed PMID: 8406375.

    Article  PubMed  CAS  Google Scholar 

  35. Hennes EM, Zeniya M, Czaja AJ, Pares A, Dalekos GN, Krawitt EL, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology. 2008;48(1):169–76. doi:10.1002/hep.22322. PubMed PMID: 18537184.

    Article  PubMed  Google Scholar 

  36. Muratori P, Muratori L, Agostinelli D, Pappas G, Veronesi L, Granito A, et al. Smooth muscle antibodies and type 1 autoimmune hepatitis. Autoimmunity. 2002;35(8):497–500. PubMed PMID: 12765475.

    Article  PubMed  CAS  Google Scholar 

  37. Costa M, Rodriguez-Sanchez JL, Czaja AJ, Gelpi C. Isolation and characterization of cDNA encoding the antigenic protein of the human tRNP(Ser)Sec complex recognized by autoantibodies from patients withtype-1 autoimmune hepatitis. Clin Exp Immunol. 2000;121(2):364–74. PubMed PMID: 10931155; PubMed Central PMCID: PMC1905695.

    Article  PubMed  CAS  Google Scholar 

  38. Wies I, Brunner S, Henninger J, Herkel J, Kanzler S, Meyer zum Buschenfelde KH, et al. Identification of target antigen for SLA/LP autoantibodies in autoimmune hepatitis. Lancet. 2000;355(9214):1510–5. PubMed PMID: 10801173.

    Article  PubMed  CAS  Google Scholar 

  39. Ma Y, Okamoto M, Thomas MG, Bogdanos DP, Lopes AR, Portmann B, et al. Antibodies to conformational epitopes of soluble liver antigen define a severe form of autoimmune liver disease. Hepatology. 2002;35(3):658–64. doi:10.1053/jhep.2002.32092. PubMed PMID: 11870381.

    Article  PubMed  CAS  Google Scholar 

  40. Vuppalanchi R, Gould RJ, Wilson LA, Unalp-Arida A, Cummings OW, Chalasani N, et al. Clinical significance of serum autoantibodies in patients with NAFLD: results from the nonalcoholic steatohepatitis clinical research network. Hepatol Int. 2011. doi: 10.1007/s12072-011-9277-8. PubMed PMID: 21557024; PubMed Central PMCID: PMC3511661.

  41. Alswat K, Al-Harthy N, Mazrani W, Alshumrani G, Jhaveri K, Hirschfield GM. The spectrum of sclerosing cholangitis and the relevance of IgG4 elevations in routine practice. Am J Gastroenterol. 2012;107(1):56–63. doi:10.1038/ajg.2011.375. PubMed PMID: 22068666.

    Article  PubMed  CAS  Google Scholar 

  42. Hamano H, Kawa S, Horiuchi A, Unno H, Furuya N, Akamatsu T, et al. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med. 2001;344(10):732–8. doi:10.1056/NEJM200103083441005. PubMed PMID: 11236777.

    Article  PubMed  CAS  Google Scholar 

  43. Ghazale A, Chari ST, Zhang L, Smyrk TC, Takahashi N, Levy MJ, et al. Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy. Gastroenterology. 2008;134(3):706–15. doi:10.1053/j.gastro.2007.12.009. PubMed PMID: 18222442.

    Article  PubMed  Google Scholar 

  44. Stone JH, Zen Y, Deshpande V. IgG4-related disease. N Engl J Med. 2012;366(6):539–51. doi:10.1056/NEJMra1104650. PubMed PMID: 22316447.

    Article  PubMed  CAS  Google Scholar 

  45. Bjornsson E, Chari S, Silveira M, Gossard A, Takahashi N, Smyrk T, et al. Primary sclerosing cholangitis associated with elevated immunoglobulin G4: clinical characteristics and response to therapy. Am J Ther. 2011;18(3):198–205. doi:10.1097/MJT.0b013e3181c9dac6. PubMed PMID: 20228674.

    Article  PubMed  Google Scholar 

  46. Mendes FD, Jorgensen R, Keach J, Katzmann JA, Smyrk T, Donlinger J, et al. Elevated serum IgG4 concentration in patients with primary sclerosing cholangitis. Am J Gastroenterol. 2006;101(9):2070–5. doi:10.1111/j.1572-0241.2006.00772.x. PubMed PMID: 16879434.

    Article  PubMed  CAS  Google Scholar 

  47. Zen Y, Quaglia A, Portmann B. Immunoglobulin G4-positive plasma cell infiltration in explanted livers for primary sclerosing cholangitis. Histopathology. 2011;58(3):414–22. doi:10.1111/j.1365-2559.2011.03763.x. PubMed PMID: 21348891.

    Article  PubMed  Google Scholar 

  48. Zhang L, Lewis JT, Abraham SC, Smyrk TC, Leung S, Chari ST, et al. IgG4+ plasma cell infiltrates in liver explants with primary sclerosing cholangitis. Am J Surg Pathol. 2010;34(1):88–94. doi:10.1097/PAS.0b013e3181c6c09a. PubMed PMID: 20035148.

    Article  PubMed  Google Scholar 

  49. Nakazawa T, Ohara H, Sano H, Ando T, Aoki S, Kobayashi S, et al. Clinical differences between primary sclerosing cholangitis and sclerosing cholangitis with autoimmune pancreatitis. Pancreas. 2005;30(1):20–5. PubMed PMID: 15632695.

    PubMed  Google Scholar 

  50. Hart PA, Topazian MD, Witzig TE, Clain JE, Gleeson FC, Klebig RR, et al. Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab: the Mayo Clinic experience. Gut. 2012. doi: 10.1136/gutjnl-2012-302886. PubMed PMID: 22936672.

  51. Sodikoff JB, Keilin SA, Cai Q, Bharmal SJ, Lewis MM, Raju GS, et al. Mycophenolate mofetil for maintenance of remission in steroid-dependent autoimmune pancreatitis. World J Gastroenterol. 2012;18(18):2287–90. doi:10.3748/wjg.v18.i18.2287. PubMed PMID: 22611324; PubMed Central PMCID: PMC3351781.

    Article  PubMed  CAS  Google Scholar 

  52. Tomiyama T, Uchida K, Matsushita M, Ikeura T, Fukui T, Takaoka M, et al. Comparison of steroid pulse therapy and conventional oral steroid therapy as initial treatment for autoimmune pancreatitis. J Gastroenterol. 2011;46(5):696–704. doi:10.1007/s00535-010-0361-y. PubMed PMID: 21188426.

    Article  PubMed  CAS  Google Scholar 

  53. Kamisawa T, Shimosegawa T, Okazaki K, Nishino T, Watanabe H, Kanno A, et al. Standard steroid treatment for autoimmune pancreatitis. Gut. 2009;58(11):1504–7. doi:10.1136/gut.2008.172908. PubMed PMID: 19398440.

    Article  PubMed  CAS  Google Scholar 

  54. Church NI, Pereira SP, Deheragoda MG, Sandanayake N, Amin Z, Lees WR, et al. Autoimmune pancreatitis: clinical and radiological features and objective response to steroid therapy in a UK series. Am J Gastroenterol. 2007;102(11):2417–25. doi:10.1111/j.1572-0241.2007.01531.x. PubMed PMID: 17894845.

    Article  PubMed  CAS  Google Scholar 

  55. Drebber U, Kasper HU, Ratering J, Wedemeyer I, Schirmacher P, Dienes HP, et al. Hepatic granulomas: histological and molecular pathological approach to differential diagnosis—a study of 442 cases. Liver Int. 2008;28(6):828–34. doi:10.1111/j.1478-3231.2008.01695.x. PubMed PMID: 18312287.

    Article  PubMed  CAS  Google Scholar 

  56. Gaya DR, Thorburn D, Oien KA, Morris AJ, Stanley AJ. Hepatic granulomas: a 10 year single centre experience. J Clin Pathol. 2003;56(11):850–3. PubMed PMID: 14600131; PubMed Central PMCID: PMC1770104.

    Article  PubMed  CAS  Google Scholar 

  57. McCluggage WG, Sloan JM. Hepatic granulomas in Northern Ireland: a thirteen year review. Histopathology. 1994;25(3):219–28. PubMed PMID: 7821889.

    Article  PubMed  CAS  Google Scholar 

  58. Satti MB, al-Freihi H, Ibrahim EM, Abu-Melha A, al-Ghassab G, al-Idrissi HY, et al. Hepatic granuloma in Saudi Arabia: a clinicopathological study of 59 cases. Am J Gastroenterol. 1990;85(6):669–74.

    PubMed  CAS  Google Scholar 

  59. Dourakis SP, Saramadou R, Alexopoulou A, Kafiri G, Deutsch M, Koskinas J, et al. Hepatic granulomas: a 6-year experience in a single center in Greece. Eur J Gastroenterol Hepatol. 2007;19(2):101–4. doi:10.1097/01.meg.0000243882.09820.d2. PubMed PMID: 17272993.

    Article  PubMed  Google Scholar 

  60. Geramizadeh B, Jahangiri R, Moradi E. Causes of hepatic granuloma: a 12-year single center experience from southern Iran. Arch Iran Med. 2011;14(4):288–9. doi:0011144/AIM.0012. PubMed PMID: 21726107.

    PubMed  Google Scholar 

  61. Ebert EC, Kierson M, Hagspiel KD. Gastrointestinal and hepatic manifestations of sarcoidosis. Am J Gastroenterol. 2008;103(12):3184–92; quiz 93. doi: 10.1111/j.1572-0241.2008.02202.x. PubMed PMID: 18853979.

    Google Scholar 

  62. Kennedy PT, Zakaria N, Modawi SB, Papadopoulou AM, Murray-Lyon I, du Bois RM, et al. Natural history of hepatic sarcoidosis and its response to treatment. Eur J Gastroenterol Hepatol. 2006;18(7):721–6. doi:10.1097/01.meg.0000223911.85739.38. PubMed PMID: 16772828.

    Article  PubMed  CAS  Google Scholar 

  63. Alam I, Levenson SD, Ferrell LD, Bass NM. Diffuse intrahepatic biliary strictures in sarcoidosis resembling sclerosing cholangitis. Case report and review of the literature. Dig Dis Sci. 1997;42(6):1295–301. doi:10.1023/A:1018874612166. PubMed PMID: 9201098.

    Article  PubMed  CAS  Google Scholar 

  64. Boursiquot JN, Gerard L, Malphettes M, Fieschi C, Galicier L, Boutboul D, et al. Granulomatous disease in CVID: retrospective analysis of clinical characteristics and treatment efficacy in a cohort of 59 patients. J Clin Immunol. 2013;33(1):84–95. doi:10.1007/s10875-012-9778-9. PubMed PMID: 22986767.

    Article  PubMed  CAS  Google Scholar 

  65. Ardeniz O, Cunningham-Rundles C. Granulomatous disease in common variable immunodeficiency. Clin Immunol. 2009;133(2):198–207. doi:10.1016/j.clim.2009.05.001. PubMed PMID: 19716342; PubMed Central PMCID: PMC2760682.

    Article  PubMed  CAS  Google Scholar 

  66. Malamut G, Ziol M, Suarez F, Beaugrand M, Viallard JF, Lascaux AS, et al. Nodular regenerative hyperplasia: the main liver disease in patients with primary hypogammaglobulinemia and hepatic abnormalities. J Hepatol. 2008;48(1):74–82. doi:10.1016/j.jhep.2007.08.011. PubMed PMID: 17998147.

    Article  PubMed  Google Scholar 

  67. Cunningham-Rundles C, Bodian C. Common variable immunodeficiency: clinical and immunological features of 248 patients. Clin Immunol. 1999;92(1):34–48. doi:10.1006/clim.1999.4725. PubMed PMID: 10413651.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of California Davis Medical Center, 4150 V Street, PSSB 3500, Sacramento, CA, 95817, USA

    Christopher L. Bowlus

Authors
  1. Christopher L. Bowlus
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christopher L. Bowlus .

Editor information

Editors and Affiliations

  1. Division of Rheumatology, Allergy and Clinical Immunology, University of California School of Medicine, Davis, California, USA

    M. Eric Gershwin

  2. Medicine and Surgery, Baylor College of Medicine, Houston, Texas, USA

    John M. Vierling

  3. Department of Gastroenterology, Hepatology and Endocrinology, Medical School of Hannover, Germany

    Michael P. Manns

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Bowlus, C.L. (2014). Diagnostic Liver Immunology. In: Gershwin, M., Vierling, J., Manns, M. (eds) Liver Immunology. Springer, Cham. https://doi.org/10.1007/978-3-319-02096-9_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-02096-9_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-02095-2

  • Online ISBN: 978-3-319-02096-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation