Recommendation

1.

A diagnosis of PBC/AIH overlap syndrome should be considered in the presence of simultaneous mixed hepatocellular and cholestatic hepatitis picture, with positive autoimmune markers including AMA, and supported by liver biopsy findings of moderate to severe interface hepatitis, or sudden deterioration of stable disease (i.e. PBC or AIH evident clinically or based on laboratory diagnostics) in consecutive presentation. (Grade II-3/C)

2.

A close observation of patients with overlap syndromes is recommended as they tend to exhibit significantly higher rates of liver-related complication and need for LT compared with those with AIH or PBC alone. (Grade II-3/C)