Impact of gender on the long-term outcome and survival of patients with autoimmune hepatitis.
OBJECTIVE
Autoimmune hepatitis (AIH) predominantly affects women. Reasons for this are unclear and few series have assessed long-term outcomes of men with AIH.


METHODS
To evaluate the clinical course and outcomes of 51 men from a total of 238 consecutive patients with definite AIH at a single centre from 1971 to 2005. The primary outcome measure was death or liver transplantation.


RESULTS
Median age at diagnosis was 39 y in men and 49 y in women (p = 0.0589). HLA A1, B8 and DR3 allotypes and the HLA A1-B8-DR3 haplotype were more frequently expressed in men (63% vs. 45%, p = 0.049; 74% vs. 38%, p < 0.001; 62% vs. 44%, p = 0.058; and 50% vs. 23%, p = 0.003; respectively). There were no significant differences in clinical manifestations at presentation. Over 96% of patients demonstrated a complete initial response to treatment. A greater number of men experienced at least one relapse (71% vs. 55%, p = 0.0591). However, women were significantly more likely to die or require liver transplantation (Log rank test p = 0.024).


CONCLUSIONS
Men with AIH appear to have a higher relapse rate and younger age of disease onset which may relate to increased prevalence of HLA A1-B8-DR3. Despite this, men have significantly better long-term survival and outcomes than women.
Al-Chalabi
Thawab
T
Institute of Liver Studies, King's College Hospital, Denmark Hill, London, UK.
Underhill
James A
JA
Portmann
Bernard C
BC
McFarlane
Ian G
IG
Heneghan
Michael A
MA
D000328:Adult; D017668:Age of Onset; D000704:Analysis of Variance; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001323:Autoantibodies / Q000032:analysis / Q000276:immunology; D001379:Azathioprine / Q000627:therapeutic use; D005060:Europe / Q000453:epidemiology; D005260:Female; D019693:Hepatitis, Autoimmune / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007962:Leukocytes / Q000276:immunology; D008099:Liver / Q000473:pathology; D008111:Liver Function Tests; D008134:Long-Term Care; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D012008:Recurrence; D012727:Sex Characteristics; D012744:Sex Ratio; D016019:Survival Analysis; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D001323:Autoantibodies; D007166:Immunosuppressive Agents; D011239:Prednisolone; D001379:Azathioprine