In autoimmune hepatitis patients on azathioprine who develop NRH/OPV features, how do you determine whether azathioprine is the driver versus AIH-related vascular injury, and what is your usual immunosuppression adjustment when portal hypertension is emerging but AIH control is fragile?

The development of NRH is related to the thiopurine, in this case azathioprine, which should be stopped.

I'm not sure how valuable or even if possible, to determine the mechanism of the vascular injury, but AZA needs to be discontinued.

The reasonable alternative is to start mycophenolate and try to...