When should I consider referring a patient with autoimmune hepatitis to a specialist for further evaluation and management?

Consider referring a patient with autoimmune hepatitis to a specialist hepatologist or gastroenterologist with an interest in hepatology for further evaluation and management in the following situations:

• If the patient shows signs of decompensated liver disease, such as ascites, encephalopathy, or gastrointestinal haemorrhage, arrange immediate referral or emergency admission.
• If autoimmune hepatitis is suspected or diagnosed and the patient is not already under specialist care, refer for specialist assessment to confirm diagnosis, assess liver damage, and initiate appropriate treatment.
• If there is evidence of cirrhosis or advanced liver fibrosis, refer to a hepatologist for further management and monitoring.
• Consider referral if the patient requires specialist investigations such as liver biopsy, transient elastography, or assessment for hepatocellular carcinoma surveillance.
• Referral is also appropriate if the patient has complications or comorbidities that require specialist input, or if treatment with immunosuppressive or other specialist therapies is indicated.

Early specialist involvement is important to optimise management, prevent progression, and coordinate long-term care including monitoring for complications.

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