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. 2022 Mar 14.
doi: 10.1111/liv.15241. Online ahead of print.

Treatment and Outcome of Autoimmune Hepatitis (AIH): Audit of 28 UK centres

Victoria Gordon  1 , Ratul Adhikary  2 , Victoria Appleby  3 , Debasish Das  4 , James Day  5 , Toby Delahooke  6 , Selena Dixon  7 , David Elphick  8 , Claire Hardie  9 , Michael A Heneghan  10 , Barbara Hoeroldt  11 , Patricia Hooper  12 , John Hutchinson  13 , Rebecca Jones  14 , Faisal Khan  15 , Guruprasad P Aithal  16 , Jane Metcalf  17 , Alick Nkhoma  18 , Stavroula Pelitari  1 , Martin Prince  19 , Annell Prosser  20 , Vinay Sathyanarayana  21 , Sushma Saksena  22 , Deven Vani  23 , Andrew Yeoman  24 , George Abouda  25 , Andrew Nelson  26 , Dermot Gleeson  27 ; UK Multi-Centre AIH Audit Group (see acknowledgements for other contributors)
Affiliations

Treatment and Outcome of Autoimmune Hepatitis (AIH): Audit of 28 UK centres

Victoria Gordon et al. Liver Int. .

Abstract

Background: With few data regarding treatment and outcome of patients with AIH outside of large centres we present such a study of patients with AIH in 28 UK hospitals of varying size and facilities.

Methods: Patients with AIH were identified in 14 University and 14 District General hospitals; incident cases during 2007-2015 and prevalent cases, presenting 2000-2015. Treatment and outcomes were analysed.

Results: In 1267 patients with AIH, followed-up for 3.8(0-15) years, 5- and 10-year death/transplant rates were 7.1+0.8% and 10.1+1.3% (all-cause) and 4.0+0.6% and 5.9+1% (liver-related) respectively. Baseline parameters independently associated with death/transplantation for all-causes were: older age, vascular/respiratory co-morbidity, cirrhosis, decompensation, platelet count, attending transplant centre and for liver-related: the last four of these and peak bilirubin All-cause and liver-related death/transplantation was independently associated with: non-treatment with corticosteroids, non-treatment with a steroid-sparing agent (SSA), non-treatment of asymptomatic or non-cirrhotic patients and initial dose of Prednisolone >35mg/0.5mg/kg/day (all-cause only), but not with type of steroid (Prednisolone versus Budesonide) or steroid duration beyond 12-months. Subsequent all-cause and liver-death/transplant rates showed independent associations with smaller percentage fall in serum ALT after 1 and 3-months, but not with failure to normalise levels over 12-months.

Conclusions: We observed higher death/transplant rates in patients with AIH who were untreated with steroids (including asymptomatic or non-cirrhotic sub-groups), those receiving higher Prednisolone doses and those who did not receive an SSA. Similar death/transplant rates were seen in those receiving Prednisolone or Budesonide, those continuing steroids after 12-months and patients attaining normal ALT within 12-months versus not.

Keywords: Autoimmune hepatitis; Budesonide; Prednisolone; outcome; treatment.

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