Difference in clinical presentation, immunology profile and treatment response of type 1 autoimmune hepatitis between United Kingdom and Singapore patients.
BACKGROUND
Autoimmune hepatitis (AIH) is an immune-mediated liver disease of unknown etiology. Increasing incidence of AIH in Asian patients has been reported. However, the phenotypic difference of Asian patients in Europe and Asia has still not been explored.


OBJECTIVE
To evaluate the clinical presentation, biochemical and immunological profiles, treatment response and survival outcome of type 1 AIH from two tertiary liver transplant centres (United Kingdom and Singapore).


METHODS
Patients who fulfilled the simplified diagnostic scoring criteria of AIH were included in the study. Patients with overlap syndrome were excluded.


RESULTS
Totals of 40 Asian patients and 159 Caucasian patients from the University Hospital of Birmingham National Health Service Foundation Trust, UK, were compared with 57 Asian patients from Singapore General Hospital, Singapore. Asian patients from Singapore present significantly much later (median 55 vs. 32 years, p < 0.001), had higher MELD (p < 0.001) with lower albumin (p < 0.001) and higher bilirubin (p < 0.001) and lower ASMA positivity (p < 0.001) at diagnosis compared to UK Asian. Jaundice at presentation was much higher in Singapore Asian patients compared to UK Asian (53 vs. 30 %) but cirrhosis at diagnosis was more common in UK patients. Associated autoimmune conditions were less commonly seen in Singapore Asians. Comparing between UK cohorts, Asian patients present at younger age and have higher IgG level compared to Caucasian. Overall, 5-year transplant-free survival in all three cohorts was similar (p = 0.846).


CONCLUSIONS
We demonstrate that AIH patients from Singapore present at older age with jaundice and have a low positivity of SMA. Despite these differences, transplant-free survival is similar in the two groups.
Centre for Liver Research and NIHR Biomedical Research Unit in Liver Diseases, Institute of Immunology and Immunotherapy, University of Birmingham, Vincent Drive, Edgbaston, Birmingham, B15 2TT, UK.|Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, Birmingham, UK.
Nwe Ni
NN
Than
Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore.
Doreen Koay Siew
DK
Ching
Institute of Translational Medicine, Queen Elizabeth Hospital, Birmingham, UK.
James
J
Hodson
Centre for Liver Research and NIHR Biomedical Research Unit in Liver Diseases, Institute of Immunology and Immunotherapy, University of Birmingham, Vincent Drive, Edgbaston, Birmingham, B15 2TT, UK.
Patrick
P
McDowell
Leeds General Infirmary, Leeds, UK.
Jake
J
Mann
Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, Birmingham, UK.
Ravi
R
Gupta
Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore.
Ennaliza
E
Salazar
Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore.
Jing Hieng
JH
Ngu
Centre for Liver Research and NIHR Biomedical Research Unit in Liver Diseases, Institute of Immunology and Immunotherapy, University of Birmingham, Vincent Drive, Edgbaston, Birmingham, B15 2TT, UK. y.h.oo@bham.ac.uk.|Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, Birmingham, UK. y.h.oo@bham.ac.uk.
Ye Htun
YH
Oo
D000328:Adult; D005260:Female; D019693:Hepatitis, Autoimmune / Q000208:ethnology* / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D007565:Jaundice / Q000208:ethnology / Q000276:immunology / Q000473:pathology / Q000628:therapy; D008103:Liver Cirrhosis / Q000208:ethnology / Q000276:immunology / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012846:Singapore; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
D007074:Immunoglobulin G
Asian; Autoimmune hepatitis; Caucasian; Clinical features; Ethnicity; Immunology; Survival