Long-term outcome of autoimmune hepatitis: Consecutive patient cohort and data on the second 20 years

Background: Mortality rates for autoimmune hepatitis (AIH) vary. Data are lacking beyond 20 years follow-up.
Aims: Analysis of a consecutively recruited large AIH cohort from a single non-transplant tertiary center in England and an overlapping cohort, already followed for ≥ 20 years.
Methods: The authors assessed 330 patients presenting 1987–2016 and 65 patients presenting 1971–1996 already followed for 20 years.
Results: Death/liver transplant rate was 51 ± 4% (all-cause) and 21 ± 4% (liver-related) over 20 years and was independently associated with: decompensation and lower serum alanine aminotransferase (ALT) at diagnosis; and failure of serum ALT normalization and higher relapse rate. There was excess mortality over the first year. Patients (n = 65) already followed for 20 years had similar subsequent rates of relapse, disease progression and mortality, to those followed from diagnosis. Azathioprine-intolerant patients (n = 23) switching to mycophenolate did not have higher mortality over 4 (1–17) years, than patients continuing azathioprine. Following immunosuppression withdrawal (n = 26), 6 patients (23%) relapsed with no liver-related deaths over 2.3 (0–23.1) years.

Conclusions: In this consecutive autoimmune hepatitis cohort, mortality was similar to that in national registry studies, disease progression continued after 20 years, and immunosuppression withdrawal did not compromise survival.

L. Harrison, Liver Unit, Northern General Hospital, Sheffield, UK, E-Mail: laura.harrison11@nhs.net

DOI: 10.1016/j.dld.2023.06.014

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