Favorable outcomes of autoimmune hepatitis in a community clinic setting.
OBJECTIVE
Autoimmune hepatitis (AIH) is an idiopathic disease with diverse clinical manifestations. The aims of the present study were: (i) to describe the clinical characteristics of AIH patients in a community clinic setting; and (ii) to determine factors which were associated with poor clinical outcomes.


METHODS
A retrospective review was performed on 72 AIH patients who: (i) had pretreatment sera: (ii) were treatment-naïve at presentation; and (iii) had a minimum of 24 months of follow up.


RESULTS
On initial presentation, 22 (30%) had an acute onset of symptoms simulating acute viral hepatitis, 34 (47%) had chronic symptoms of greater than 6 months duration, and the remaining 16 (22%) were asymptomatic. Twenty-six (36%) had coexisting autoimmune diseases. Anti-nuclear antibody (ANA) was positive in 73% of the patients, and antismooth muscle antibody was positive in 15% of ANA-negative patients. Those few patients who tested positive for soluble liver antigen, anti-liver-kidney, microsomal antibody type-1, and anti-mitochondrial antibody were all also ANA positive. The median (range) duration of follow up was 98 (24-331) months. After immunosuppressive therapy, 26 of 72 (36%) remained in remission without further treatment. However, 46 (64%) required maintenance immunosuppression. Three patients who presented under the age of 20 years progressed to liver failure while on therapy and died while waiting for liver transplantation. Two other patients developed hepatocellular carcinoma (HCC) while on therapy and died.


CONCLUSIONS
A majority of AIH patients have an excellent prognosis. However, presentation at a younger age is a predictor of poor disease outcome and, although uncommon, HCC may develop during the late stages of cirrhosis.
Seo
Suk
S
Medicine and Surgery, David Geffen School of Medicine at UCLA, The Pfleger Liver Institute, Los Angeles, California 90095-7302, USA. sseo@mednet.ucla.edu
Toutounjian
Raphael
R
Conrad
Andrew
A
Blatt
Larry
L
Tong
Myron J
MJ
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000974:Antibodies, Antinuclear / Q000097:blood; D001323:Autoantibodies / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003153:Community Health Services; D018450:Disease Progression; D005260:Female; D019693:Hepatitis, Autoimmune / Q000150:complications / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007519:Isoantigens / Q000097:blood; D008103:Liver Cirrhosis / Q000209:etiology / Q000628:therapy; D017093:Liver Failure / Q000209:etiology / Q000628:therapy; D008113:Liver Neoplasms / Q000209:etiology / Q000628:therapy; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
D000974:Antibodies, Antinuclear; D001323:Autoantibodies; D007166:Immunosuppressive Agents; D007519:Isoantigens