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Prediction of short- and long-term outcome in patients with autoimmune hepatitis

Kirstein, Martha M., Metzler, Frauke, Geiger, Elena, Heinrich, Eyk, Hallensleben, Michael, Manns, Michael P., Vogel, Arndt·2015·Hepatology
DOI 10.1002/hep.27983
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Abstract

Autoimmune hepatitis (AIH) is a chronic inflammatory disease characterized by a loss of tolerance toward the hepatocellular epithelium. Liver transplantation (LT) represents the ultimate therapeutic option for a fulminant course or end‐stage liver disease. The aim of this study was to elucidate the clinical, serological, and genetic features of remission, relapse, and overall and LT‐free survival. Between 2000 and 2014, 354 AIH patients from Hannover Medical School were included. Clinical, laboratory, and histological reports were analyzed. DRB1 allele analyses were performed in 264 AIH and 399 non‐AIH patients. Cox's regression analysis was performed to identify factors significantly associated with survival. Patients diagnosed in childhood were at higher risk for relapses ( P = 0.003), requirement for LTs ( P = 0.014, log rank), and had a reduced life expectancy ( P < 0.001, log rank). Detection of soluble liver antigen/liver pancreas antigen (SLA/LP) antibodies was significantly associated with reduced overall and LT‐free survival ( P = 0.037; P = 0.021). Cirrhosis, which was evident in 25% at first diagnosis, was found to be a predictor of poor survival and requirement for LT ( P = 0.003; P = 0.009). DRB1*04:01‐positive phenotype was associated with a higher rate of complete remissions and with a lower frequency of cirrhosis and LTs. There were no significant differences for subsequent relapses or survival in patients achieving either partial or complete remission. Conclusion : Diagnosis <18 years, histological cirrhosis at first diagnosis and SLA/LP antibodies are major risk factors for a poor short‐ and long‐term outcome. These patients are in need of high surveillance. Separating patients with positive SLA/LP antibodies into a third group may be reconsidered. DRB1*04:01 positivity has been identified in association with a favorable clinical outcome. (H epatology 2015;62:1524–1535)

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Authors
Kirstein, M. M., Metzler, F., Geiger, E., Heinrich, E., Hallensleben, M., Manns, M. P., & Vogel, A.
Affiliations
  • Hannover Medical School, Department of Gastroenterology, Hepatology and Endocrinology,Hannover,Germany
  • Hannover Medical School, Institute for Transfusion Medicine,Hannover,Germany
Venue
Hepatology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2015-08-25
Volume
62
Issue
5
Pages
1524-1535
ISSN
  • 0270-9139
  • 1527-3350
DOI
10.1002/hep.27983
Cited by
136
References
0
Language
en
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 7 d)

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