Background: Autoimmune hepatitis (AIH) is an immune mediated chronic liver diseasewith a prevalence of 17 cases/100,000. Resistance to the standard treatment of AIH (prednisone and azathioprine) occurs in 15%to 20%. There is currently no standard treatment of patients with steroid refractory AIH. Goals: Determine the efficacy of tacrolimus in the treatment of steroid refractory AIH. Methods: This is a retrospective study evaluating the efficacy of Tacrolimus in the treatment of steroid refractory AIH. Results: Between October 1998 and February 2002, 11 patients with steroid refractory AIH were treated with tacrolimus. Mean age was 63 years. Median duration of steroid treatment before starting tacrolimus was 9 months. Median duration of tacrolimus treatment was 25 months. Median follow up period was 16 months. Median baseline ALT, AST were 77 U/L and 68 U/L and became 21 U/L and 32 U/L respectively at end of follow up (P = 0.005 and 0.01 respectively). Significant weight reduction was seen in all patients (P = 0.02). Tacrolimus treatment was safe and well tolerated. Conclusion: Use of low dose tacrolimus led to successful biochemical and histologic remission and weaning off prednisone in patients with steroid refractory AIH. This data supports further studies in evaluating the use of tacrolimus in the treatment of AIH. There is currently no standard treatment of patients (AIH) is an immune mediated chronic liver disease with a prevalence of 17 cases / 100,000. Resistance to the standard treatment of AIH (prednisone and azathioprine) occurs in 15% to 20%. with steroid refractory AIH. Goals: Determine the efficacy of tacrolimus in the treatment of steroid refractory AIH. Methods: This is a retrospective study evaluating the efficacy of Tacrolimus in the treatment of steroid refractory AIH. Results: Between October 1998 and February 2002, 11 Patients with steroid refractory AIH were treated with tacrolimus. Mean age was 63 years. Median duration of steroid treatment before starting tacrolimus was 9 months. Median duration of tacrolimus treatment was 25 months. Median follow up period was 16 months. Median baseline ALT, AST were 77 U / L and 68 U / L and became 21 U / L and 32 U / L respectively at end of follow up (P = 0.005 and 0.01 respectively). Significant weight reduction was s Tacrolimus treatment was safe and well tolerated. Conclusion: Use of low dose tacrolimus led to successful biochemical and histologic remission and weaning off prednisone in patients with steroid refractory AIH. This data supports further studies in evaluating the use of tacrolimus in the treatment of AIH.