Autoimmune Hepatitis: Predictors of Native Liver Survival in Children and Adolescents

Abstract

To determine predictors of native liver survival (NLS) in children and adolescents with autoimmune hepatitis (AIH). The medical records of children and adolescents with AIH were reviewed. A questionnaire was used to collect data on clinical presentation, biochemical and histologic findings, and treatment. A total of 819 patients were included, 89.6% with AIH-1 and 10.4% with AIH-2. The median age (months) at onset was 108 (min 6; max 210; IQR 59). The female sex was predominant (75.8%). The overall survival was 93.0%, with an NLS of 89.9%; 4.6% underwent liver transplantation. The risk of death or liver transplantation during follow-up was 3.2 times greater in patients with AIH-1 (P=.024). Greater levels of aspartate aminotransferase, alanine aminotransferase, serum albumin, platelet, and normal international normalized ratio at the initial presentation were associated with longer NLS (P=.046, P=.006, P<.001, P=.001, and P=.019, respectively). Normal C3 levels was associated with longer NLS (P=.017), with a chance of death or liver transplantation during follow-up being 3.4 times greater in patients with C3 below normal. Death or liver transplantation during follow-up was 2.8 times greater in patients with associated sclerosing cholangitis (P=.046). Complete remission favored NLS (P<.001), with a risk of death or liver transplantation 11.7 times greater for patients not achieving remission. The best predictors of NLS in children and adolescents with AIH were the AIH-2 subtype, a normal C3 at diagnosis, remission during treatment, and normal a cholangiogram during the disease course.