Frequency, behavior, and prognostic implications of antimitochondrial antibodies in type 1 autoimmune hepatitis.
BACKGROUND
Antimitochondrial antibodies (AMA) can occur in autoimmune hepatitis, but their durability and prognostic significance are uncertain.


OBJECTIVE
Determine the frequency, behavior, and prognostic implications of AMA in type 1 autoimmune hepatitis.


METHODS
One hundred thirty patients were tested for AMA by the same enzyme-linked immunosorbent assay at accession and during 123+/-9 months of observation (mean, 6+/-0.2 determinations/patient). Findings were correlated with clinical and histologic features and treatment outcomes.


RESULTS
Twenty-four patients (18%) had AMA, including 17 who had the antibodies at accession (71%) and 7 who developed them during follow-up (29%). AMA persisted in 13 patients (54%) who were tested on 5+/-1 occasions during 141+/-33 months. Cholestatic histologic features occurred as commonly in patients with and without AMA at presentation (18% vs. 10%, P=0.4). AMA disappeared in 4 patients, and they developed in 7 patients after 34+/-7 months. Late expression of antibodies was not associated with a higher frequency of cholestatic histologic changes than continued seronegativity (14% vs. 9%, P=0.5). Remission (83% vs. 76%, P=0.4) and treatment failure (8% vs. 11%, P>0.9) occurred as commonly in both groups.


CONCLUSIONS
AMA can appear and disappear. They do not identify a subgroup that requires different treatment or that evolves quickly into a cholestatic syndrome.
Montano-Loza
Aldo J
AJ
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Carpenter
Herschel A
HA
Czaja
Albert J
AJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000276:immunology*; D002779:Cholestasis / Q000276:immunology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D019693:Hepatitis, Autoimmune / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008930:Mitochondria, Liver / Q000276:immunology*; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D012698:Serologic Tests; D016896:Treatment Outcome
D001323:Autoantibodies