Early treatment response predicts the need for liver transplantation in autoimmune hepatitis.
BACKGROUND
The need for immunosuppression in autoimmune hepatitis is established. Previous studies have investigated short-term outcomes in patients who respond to treatment. This study assesses long-term prognosis of patients who fail to respond to standard immunosuppression.


METHODS
163 charts were reviewed, composed of 108 non-transplant patients and 55 patients who required liver transplantation (LT). Clinical endpoints were based on aminotransaminases: early treatment response (ER) was a 50% improvement at 6 months of therapy, Complete remission (CR) was an improvement to <2X normal, Relapse was worsening to >3X normal, Incomplete response (IR) was some response but no CR in 3 years, and No response (NR) was no improvement after 3 years.


RESULTS
85% of non-LT and 25% of LT patients achieved ER, 91% of non-LT and 26% of LT patients achieved CR. 41% of non-LT patients relapsed on maintenance treatment, and 41% of non-LT patients relapsed when withdrawn from treatment. 9% of non-LT and 58% of LT patients had IR. 16% in LT group showed NR, while all non-LT patients showed some response. All paired comparisons were statistically different (P<0.05). Multiple regression analysis revealed that lack of ER predicts need for LT (P=0.0005). 87% of patients who achieved ER did not require LT, whereas 16% of patients who failed ER showed NR and all required LT. Odds ratio of a patient who failed ER proceeding to LT, compared to a patient who achieved ER, was 16.8 (7.5 to 37.7, 95% CI).


CONCLUSIONS
Patients who fail to show a 50% improvement in transaminases at 6 months of standard immunosuppression should be considered for alternate treatment modalities or be referred earlier for LT.
Division of Gastroenterology, Department of Medicine, London Health Sciences Centre, London, ON, Canada. ptan@uwo.ca
Patrick
P
Tan
Paul
P
Marotta
Cameron
C
Ghent
Paul
P
Adams
D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D004359:Drug Therapy, Combination; D023381:Endpoint Determination / Q000379:methods*; D005260:Female; D019693:Hepatitis, Autoimmune / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011239:Prednisolone / Q000627:therapeutic use; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D000637:Transaminases / Q000032:analysis; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D011239:Prednisolone; D000637:Transaminases; D001379:Azathioprine