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

Gordon, Victoria; Adhikary, Ratul; Appleby, Victoria; Das, Debasish; Day, James; Delahooke, Toby; Dixon, Selena; Elphick, David; Hardie, Claire; Heneghan, Michael A.; Hoeroldt, Barbara; Hooper, Patricia; Hutchinson, John; Jones, Rebecca; Khan, Faisal; Aithal, Guruprasad. P; Metcalf, Jane; Nkhoma, Alick; Pelitari, Stavroula; Prince, Martin; Prosser, Annell; Sathyanarayana, Vinay; Saksena, Sushma; Vani, Deven; Yeoman, Andrew; Abouda, George; Nelson, Andrew; Gleeson, Dermot

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.

Citation

Gordon, V., Adhikary, R., Appleby, V., Das, D., Day, J., Delahooke, T., Dixon, S., Elphick, D., Hardie, C., Heneghan, M. A., Hoeroldt, B., Hooper, P., Hutchinson, J., Jones, R., Khan, F., Aithal, G. P., Metcalf, J., Nkhoma, A., Pelitari, S., Prince, M., …Gleeson, D. (2022). Treatment and Outcome of Autoimmune Hepatitis (AIH): Audit of 28 UK centres. Liver International, 42(7), 1571-1584. https://doi.org/10.1111/liv.15241

• Journal Article Type: Article
• Acceptance Date: Mar 10, 2022
• Online Publication Date: Mar 14, 2022
• Publication Date: 2022-07
• Deposit Date: Mar 17, 2022
• Publicly Available Date: Mar 15, 2023
• Journal: Liver International
• Print ISSN: 1478-3223
• Electronic ISSN: 1478-3231
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 42
• Issue: 7
• Pages: 1571-1584
• DOI: https://doi.org/10.1111/liv.15241
• Keywords: Hepatology
• Public URL: https://nottingham-repository.worktribe.com/output/7609282
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1111/liv.15241
• Additional Information: This is the peer reviewed version of the following article: Gordon, V., Adhikary, R., Appleby, V., Das, D., Day, J., Delahooke, T., Dixon, S., Elphick, D., Hardie, C., Heneghan, M.A., Hoeroldt, B., Hooper, P., Hutchinson, J., Jones, R., Khan, F., Aithal, G.P., Metcalf, J., Nkhoma, A., Pelitari, S., Prince, M., Prosser, A., Sathyanarayana, V., Saksena, S., Vani, D., Yeoman, A., Abouda, G., Nelson, A., Gleeson, D. and (2022), Treatment and Outcome of Autoimmune Hepatitis (AIH): Audit of 28 UK centres. Liver Int. Accepted Author Manuscript, which has been published in final form at https://doi.org/10.1111/liv.15241. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.