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achieved CR. 41% of non-LT patients relapsed on maintenance treatment, and 41% of non-LT patients relapsed when withdrawn from treatment. 9% of non-LT and 58% of LT patients had IR. 16% in LT group showed NR, while all non-LT patients showed some response.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.
Tan
Patrick
P
Division of Gastroenterology, Department of Medicine, London Health Sciences Centre, London, ON, Canada. ptan@uwo.ca
Marotta
Paul
P
Ghent
Cameron
C
Adams
Paul
P
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