New research reports that cirrhosis at first diagnosis and antibodies
for the soluble liver antigen/liver pancreas antigen (SLA/LP) are major
risk factors for poor short- and long-term outcome in patients with
autoimmune hepatitis. Results published in Hepatology,
a journal of the American Association for the Study of Liver Diseases,
also found that patients diagnosed in childhood were at higher risk of
relapse, need of a liver transplant, and reduced life expectancy.
Autoimmune hepatitis is a chronic inflammatory disease in which the
immune system attacks healthy liver cells causing damage to the organ.
There are three types of autoimmune hepatitis based upon the presence of
antibodies in the blood.
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Type 1 have antinuclear and smooth muscle antibodies
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Type 2 show liver-kidney-microsome antibodies
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Type 3 (is currently not regarded as a clinically distinct AIH
subgroup) display SLA/LP antibodies
“While early diagnosis along with optimal medical therapy offers
patients with autoimmune hepatitis a good prognosis, the disease can be
very severe in some cases,” explains lead author Dr. Arndt Vogel from
Hannover Medical School in Hannover, Germany. “Our study examines the
clinical and genetic features of remission, relapse and liver
transplant-free survival in autoimmune hepatitis patients.”
The research group included patients with autoimmune hepatitis who were
treated at Hannover Medical School between 2000 and 2014. Analyses were
performed on 264 patients with the disease and 399 patients without
autoimmune hepatitis. Subjects with viral hepatitis, alcoholic and
non-alcoholic liver disease, haemochromatosis, and Wilson’s disease were
excluded.
Findings indicate that the presence of SLA/LP antibodies was
significantly associated with reduced overall and liver transplant-free
survival. Patients diagnosed with autoimmune hepatitis in childhood had
a greater relapse risk, higher risk of needing a liver transplant, and a
reduced life expectancy. In 25% of subjects cirrhosis was apparent at
first diagnosis was determined to be a predictor of poor survival and
need for liver transplantation. The DRB1*04:01 phenotype, or trait, was
linked to a higher rate of full remission and lower frequency of
cirrhosis and liver transplants.
Dr. Vogel concludes, “Autoimmune hepatitis patients diagnosed in
childhood, those that present with cirrhosis at the time of initial
diagnosis or who have SLA/LP antibodies have poor clinical outcomes,;
these patients are in need for close surveillance. On the other hand
patients with DRB1*04:01 have a better clinical outcome in the short-
and long-term suggesting that human leukocyte antigen (HLA) analysis and
screening for SLA/LP antibodies should be integrated in the clinical
routine for AIH diagnosis.
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