Liver and Bile
Clin Gastroenterol Hepatol. 2022;20(8):1776–83.e4
Aminotransferases during treatment predict long-term survival in patients with autoimmune hepatitis type 1: A landmark analysis
Background and aims: Biochemical remission, important treatment goal in autoimmune hepatitis (AIH), has been associated with better long-term survival. The aim of this study was to determine the independent prognostic value of aminotransferases and immunoglobulin (Ig)G during treatment on long-term transplant-free survival in AIH.
Methods: In a multicenter cohort alanine aminotransferase, aspartate aminotransferase (AST), and IgG were collected at diagnosis and 6, 12, 24, and 36 months after start of therapy and related to long-term outcome using Kaplan-Meier survival and Cox regression analysis with landmark analysis at these time points, excluding patients with follow-up ending before each landmark.
Results: A total of 301 AIH patients with a median follow-up of 99 (7–438) months were included. During follow-up, 15 patients required liver transplantation and 33 patients died. Higher AST at 12 months was associated with worse survival (hazard ratio [HR] = 1.86; p < 0.001), while IgG was not associated with survival (HR = 1.30; p = 0.53). In multivariate analysis AST at 12 months (HR = 2.13; p < 0.001) was predictive for survival independent of age, AST at diagnosis and cirrhosis. Multivariate analysis for AST yielded similar results at 6 months (HR = 2.61; p = 0.001), 24 months (HR = 2.93; p = 0.003), and 36 months (HR = 3.03; p = 0.010). There was a trend toward a worse survival in patients with mildly elevated aminotransferases (1–1.5 x upper limit of normal) compared with patients with normal aminotransferases (p = 0.097).
Conclusions: Low aminotransferases during treatment are associated with a better long-term survival in autoimmune hepatitis (AIH). Immunoglobulin G was not associated with survival in the first 12 months of treatment. Normalization of aminotransferases should be the treatment goal for AIH to improve long-term survival.