Liver and Bile
Eur J Gastroenterol Hepatol. 2024;36(6):742–9
Long-term outcomes of patients with autoimmune hepatitis-induced cirrhosis after immunosuppressive treatment
Introduction: Autoimmune hepatitis (AIH) is an immune-mediated liver disease that results in hepatic inflammation and subsequent fibrosis. The authors aimed to assess the natural history of AIH in patients who had cirrhosis at the time of diagnosis.
Methods: They examined consecutive patients with AIH (based on the revised International Autoimmune Hepatitis Group criteria) and cirrhosis who had long-term follow-up between 2012 and 2018. Complete clinical data, including longitudinal data, was obtained for each patient to determine clinical and biochemical outcomes. Decompensating events were defined as complications of portal hypertension.
Results: 34 patients presenting with AIH-induced cirrhosis (age 50 [17–81] years; 71% women) were followed for an average of 8 years post-diagnosis. 14 patients (41%) had a decompensating event at diagnosis. All patients were begun on treatment; index decompensating events resolved in all patients. 26 patients (76%) had normalization of transaminases; in this group, 4 patients (15%) developed 1 or more new decompensating events and 1 patient (4%) died. Of the 8 patients (24%) who did not have transaminase normalization, 6 (75%) developed 1 or more new decompensating events and 5 (62%) died or underwent liver transplant. There was a significant association between achieving normalization of transaminases and protection from developing a decompensating event (p = 0.003) and liver transplant or death (p = 0.001).
Conclusion: Most patients with autoimmune hepatitis with cirrhosis at presentation achieved normalization of transaminases with treatment and rarely developed further decompensating events. It is speculated that some of these patients had stabilization or reversal of portal hypertension.