Long-term Outcomes of Patients With Autoimmune Hepatitis Managed at a Nontransplant Center

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 140; no. 7; pp. 1980 - 1989
• Main Authors: Hoeroldt, Barbara, McFarlane, Elaine, Dube, Asha, Basumani, Pandurangan, Karajeh, Mohammed, Campbell, Michael J, Gleeson, Dermot
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2011
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Alanine Transaminase - blood; Autoimmune Disease; Biomarkers - blood; Child; Child, Preschool; England; Female; Gastroenterology and Hepatology; Hepatitis, Autoimmune - blood; Hepatitis, Autoimmune - complications; Hepatitis, Autoimmune - diagnosis; Hepatitis, Autoimmune - mortality; Hepatitis, Autoimmune - therapy; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Immunosuppressive Therapy; Kaplan-Meier Estimate; Liver Cirrhosis - etiology; Liver Transplantation - adverse effects; Liver Transplantation - mortality; Male; Middle Aged; Outcome and Process Assessment (Health Care); PBC; Prednisolone; Proportional Hazards Models; Recurrence; Retrospective Studies; Risk Assessment; Risk Factors; Survival Rate; Time Factors; Treatment Outcome; Young Adult; England; PBC; AIH; Autoimmune Disease; Immunosuppressive Therapy; IAIHG; standardized mortality ratio; autoimmune hepatitis; primary biliary cirrhosis; SMR; International Autoimmune Hepatitis Group; Prednisolone
• ISSN: 0016-5085; 1528-0012
• DOI: 10.1053/j.gastro.2011.02.065

Background & Aims The long-term outcomes of patients treated for autoimmune hepatitis (AIH) are considered to be good. However, follow-up data beyond 10 years are limited and confined to tertiary referral centers. We assessed long-term outcomes and determinants of outcome in patients with AIH from a nontransplant center. Methods We studied 245 patients (204 women; median age, 56 years; range, 2.5–87 years) with AIH (167 definite by International AIH Group criteria) managed at a single nontransplant center from 1971 to 2007. Results 229 patients (93%) achieved normal serum levels of alanine aminotransferase within 12 months after treatment. After a median follow-up period of 9.4 years (range, 0.01–36 years), 11 patients received liver transplants (2 subsequently died). Seventy other patients died (30 from liver disease), 15 were censored (moved away, defaulted, or developed primary biliary cirrhosis), and 149 were still being followed up on December 31, 2007. Survival rates from all-cause death or transplantation were 82% ± 3% and 48% ± 5% after 10 and 20 years, respectively, and from liver-related death or transplantation were 91% ± 2% and 70% ± 5%, respectively. The standardized mortality ratio was 1.63 for all-cause death (95% confidence interval [CI], 1.25–2.02), 1.86 also considering liver transplant as “death” (95% CI, 1.49–2.26), and 0.91 for non–liver-related death (95% CI, 0.62–1.19). By Cox regression analysis, liver decompensation, cirrhosis at any time, failure to normalize levels of alanine aminotransferase within 12 months, and >4 relapses per decade were significantly associated with liver-related death or transplant. Conclusions Despite a good initial response to immunosuppression, long-term mortality of patients with AIH is greater than that of the general population.