Abstract
Background & Aims: Biochemical remission, important treatment goal in autoimmune hepatitis (AIH), has been associated with better long-term survival. The aim of this study was to determine the independent prognostic value of aminotransferases and immunoglobulin G (IgG) during treatment on long-term transplant-free survival in AIH. Methods: In a multicenter cohort alanine aminotransferase, aspartate aminotransferase (AST), and IgG were collected at diagnosis and 6, 12, 24, and 36 months after start of therapy and related to long-term outcome using Kaplan-Meier survival and Cox regression analysis with landmark analysis at these time points, excluding patients with follow-up ending before each landmark. Results: A total of 301 AIH patients with a median follow-up of 99 (range, 7–438) months were included. During follow-up, 15 patients required liver transplantation and 33 patients died. Higher AST at 12 months was associated with worse survival (hazard ratio [HR], 1.86; P < .001), while IgG was not associated with survival (HR, 1.30; P = .53). In multivariate analysis AST at 12 months (HR, 2.13; P < .001) was predictive for survival independent of age, AST at diagnosis and cirrhosis. Multivariate analysis for AST yielded similar results at 6 months (HR, 2.61; P = .001), 24 months (HR, 2.93; P = .003), and 36 months (HR, 3.03; P = .010). There was a trend toward a worse survival in patients with mildly elevated aminotransferases (1–1.5× upper limit of normal) compared with patients with normal aminotransferases (P = .097). Conclusions: Low aminotransferases during treatment are associated with a better long-term survival in autoimmune hepatitis. IgG was not associated with survival in first 12 months of treatment. Normalization of aminotransferases should be the treatment goal for autoimmune hepatitis to improve long-term survival.
| Original language | English |
|---|---|
| Pages (from-to) | 1776-1783.e4 |
| Journal | Clinical Gastroenterology and Hepatology |
| Volume | 20 |
| Issue number | 8 |
| Early online date | 19 May 2021 |
| DOIs | |
| Publication status | Published - Aug 2022 |
Bibliographical note
Funding Information:The authors thank the other members of the Dutch Autoimmune Hepatitis Study Group for fruitful discussions regarding this manuscript: G. Bouma and Y. de Boer (Amsterdam UMC – location VUMC); J.P.H. Drenth (Radboud UMC Nijmegen); N.M. van Gerven (Rode Kruis ziekenhuis; Beverwijk); U. Beuers (Amsterdam UMC – location AMC); K.J. van Erpecum (UMCU Utrecht); J.W. den Ouden and A. Bhalla (Hagaziekenhuis den Haag); J.T. Brouwer (Reinier de Graaf Gasthuis Delft); J.M. Vrolijk (Rijnstate hospital Arnhem); G.H. Koek (MUMC, Maastricht); M.M.J. Guichelaar (Medisch Spectrum Twente, Enschede); E.J. van der Wouden (Isala hospital Zwolle); J.J.M van Meyel and L.C. Baak (OLVG, Amsterdam); R.C. Verdonk (St. Antonius Hospital Nieuwegein); M. Klemt-Kropp (Noordwest Ziekenhuisgroep Alkmaar); M.A.M.T. Verhagen (Diakonessenhuis, Utrecht); J.Ph. Kuijvenhoven (Spaarne Gasthuis Haarlem); H.M. de Jonge (Jeroen Bosch ziekenhuis den Bosch). Conflicts of Interest This author discloses the following: Maaike Biewenga was supported by an unrestricted grant from Zambon Pharma. The remaining authors disclose no conflicts. Funding Maaike Biewenga was supported by an unrestricted grant from Zambon Pharma.
Funding Information:
Conflicts of Interest This author discloses the following: Maaike Biewenga was supported by an unrestricted grant from Zambon Pharma. The remaining authors disclose no conflicts.
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