Outcome Of Autoimmune Hepatitis Research Articles

Проблемы антибиотикорезистентности у детей после трансплантации печени

These days, the “craze” for antibiotics has become like an epidemic and today, antibiotic resistance is a global problem. Objective.To study antibiotic resistance in children before and after surgery. Material and methods: Since March 2016, 32 liver transplants have been performed in children (from 6 months to 8 years). Of these, 23 (78.1%) patients with biliary atresia, 2 (6.2%) with cirrhosis of the liver in the outcome of autoimmune hepatitis, 1 (3.1%) with primary hyperoxaluria, 1 (3.1%) with cholangiocarcinoma, 1 (3,1%), 1 (3,1%) with inoperable hepatoblastoma, 1 (3.1%) cirrhosis of the liver in the outcome of viral hepatitis C . The number of girls was 17 (53.1%) and boys 15 (46.9%). Results:There was a 100% antibiotic intake in the preoperative period.When cross-testing design, 5 (15.6%) children with Klebsiella sepsis and with a fatal outcome were resistant to all groups of antibacterial drugs. Ethical issues: The study was conducted in accordance with the current version of the Declaration of Helsinki, in accordance with the Standard of Good Clinical Practice (GCP) (Appendix 2 to the order of the Acting Minister of Health of the Republic of Kazakhstan dated February 4, 2021 No. RK DSM-15). Conclusion. Antibiotic resistance is a major threat to global health and sustainable development, the principles of which were defined in the 2030 Agenda and the Sustainable Development Goals. It is estimated that, in the absence of effective interventions, the development of antimicrobial resistance could lead to a global death’s will increase by about 10 million cases annually. Growing concerns about antibiotic resistance have led to the adoption of a number of national, regional and global action plans in recent years to raise awareness, promote research and optimize antimicrobial use and access. Global initiatives also highlight the importance of more effective and sustainable investment in technology development and intersectoral action.

Epigenetic Aspects and Prospects in Autoimmune Hepatitis.

The observed risk of autoimmune hepatitis exceeds its genetic risk, and epigenetic factors that alter gene expression without changing nucleotide sequence may help explain the disparity. Key objectives of this review are to describe the epigenetic modifications that affect gene expression, discuss how they can affect autoimmune hepatitis, and indicate prospects for improved management. Multiple hypo-methylated genes have been described in the CD4+ and CD19+ T lymphocytes of patients with autoimmune hepatitis, and the circulating micro-ribonucleic acids, miR-21 and miR-122, have correlated with laboratory and histological features of liver inflammation. Both epigenetic agents have also correlated inversely with the stage of liver fibrosis. The reduced hepatic concentration of miR-122 in cirrhosis suggests that its deficiency may de-repress the pro-fibrotic prolyl-4-hydroxylase subunit alpha-1 gene. Conversely, miR-155 is over-expressed in the liver tissue of patients with autoimmune hepatitis, and it may signify active immune-mediated liver injury. Different epigenetic findings have been described in diverse autoimmune and non-autoimmune liver diseases, and these changes may have disease-specificity. They may also be responses to environmental cues or heritable adaptations that distinguish the diseases. Advances in epigenetic editing and methods for blocking micro-ribonucleic acids have improved opportunities to prove causality and develop site-specific, therapeutic interventions. In conclusion, the role of epigenetics in affecting the risk, clinical phenotype, and outcome of autoimmune hepatitis is under-evaluated. Full definition of the epigenome of autoimmune hepatitis promises to enhance understanding of pathogenic mechanisms and satisfy the unmet clinical need to improve therapy for refractory disease.

КЛИНИЧЕСКИЕ И ГЕМОСТАЗИОЛОГИЧЕСКИЕ ОСОБЕННОСТИ ЦИРРОЗА ПЕЧЕНИ АУТОИММУННОЙ ЭТИОЛОГИИ У ДЕТЕЙ

Objective of the study: to determine clinical, hemostasiological features and evaluate the relationship of autoantibodies with hemostasiological disorders in children with liver cirrhosis (LC) class A according to Child–Pugh score in the outcome of autoimmune hepatitis (AIH). Materials and methods of research: a single-center, retrospective, controlled, non-randomized study. From 2017 to 2021, 31 children aged 13 (10; 15.5) years old [15 girls (48%) and 16 boys (52%)] with LC class A according to Child–Pugh classification in the outcome of AIH and 15 children aged 13 (10; 15.5) years [8 girls (53%) and 7 boys (47%)], belonging to health groups I–II. All participants were examined according to the medical standard for specialized medical care for children with LC in accordance with the «Autoimmune hepatitis in children” of the Federal clinical guidelines (Moscow, 2016) and the medical standard for specialized medical care for children with AIH. The parameters of the hemostatic system were determined on the ACL-TOP 500 hemocoagulation analyzer (Instrumentation Laboratory Company, USA) using standard kits: activated partial thromboplastin time (aPTT), Prothrombin time (PT) calculated as % of prothrombin activity according to Quick, thrombin time, fibrinogen content, activity of antithrombin III (ATIII), protein C, plasminogen, alpha2-antiplasmin (α2-AP). To determine the factor XII-dependent fibrinolysis activity (XIIa-DF) and the content of Soluble fibrin monomer complexes (SFMCs), reagent kits from the Tekhnologiya-Standard company (Russia) were used. The platelet count was determined using a Cell-Dyn 610 hematology analyzer (Abbott Diagnostics, USA). The study of platelet aggregation activity was carried out on a platelet aggregation analyzer using adenosine diphosphate (ADP) at a concentration of 1.25 mg/ml and collagen at a concentration of 2.0 microns/ml as an aggregation inducer. Measurement of plasma endothelin-1 was carried out by using Endothelin 1-21 ELISA Assay kit. Homocysteine concentration and VWF activity were determined on an ACL-TOP 500 hemocoagulation analyzer (Instrumentation Laboratory Company, USA) using standard kits. Results: the clinical picture was characterized by asthenoneurotic (100%), abdominal pain (45%), hemorrhagic [ecchymosis (55%), epistaxis (30%), bleeding gums (16%)] syndromes, hepatomegaly (90%), splenomegaly ( 65%). Hemostasiological disorders were characterized by a decrease in the content of platelets (p=0.001), an increase in the degree (ADP inducer, p=0.001; collagen inducer, p=0.023) and speed (ADP inducer, p=0.003; collagen inducer, p=0.032) of their aggregation, inhibition coagulation (p=0.001) and anticoagulant (p=0.002) components of hemostasis in comparison with a group of healthy children. Positive autoantibodies were diagnosed in 97% of patients, in 49% of cases, which is typical for Type 2 AIH. Indicators of vascular-platelet hemostasis can be used to assess autoimmune activity in children with Child–Pugh class A cirrhosis: VWF activity 200.0% is associated with an increase in antinuclear antibodies (ANA) in the blood (sensitivity – 83%, specificity – 69% ). Conclusion: indicators of vascular-platelet hemostasis can be used to assess autoimmune activity in children with class A cirrhosis according to Child–Pugh in the outcome of AIH.

Persistent biochemical alteration at one year can lead to worse clinical outcomes in autoimmune hepatitis

Persistent biochemical alteration at one year can lead to worse clinical outcomes in autoimmune hepatitis

Treatment and outcomes of autoimmune hepatitis in children

Introduction. Autoimmune hepatitis (AIH) is one of the auto­im­mune liver disorders recognized in children, along with autoimmune sclerosing cholangitis (ASC) and de novo AIH after liver transplant. This study aimed to as­sess the treatment in children with AIH, and to identify cor­re­la­tions with disease outcomes. Materials and method. In this retrospective study, we included 30 hospitalized chil­­dren with AIH, followed-up in our clinic over six years. All patients met the International Autoimmune Hepatitis Group’s simplified diagnostic criteria (IAIHG criteria). Results. Pediatric patients with AIH were aged between 4 months old and 17 years and 8 months old, with a mean age of 6.5 years old. There were 19 girls and 11 boys. Most pa­tients had an acute onset of the disease. Three patients de­ve­loped acute liver failure. All patients had elevated tran­sa­mi­na­ses and 16 patients had cholestasis. Most pa­tients had increased IgG levels. There were 20 children with type I AIH with SMA and ANA, and 10 children with type II AIH with anti-LKM-1 and anti-LC-1. All patients re­ceived prednisone from the diagnosis. Fifteen patients re­quired the addition of azathioprine. Full clinical recovery with a normal level of transaminases was achieved in 18 pa­tients. Complete remission was achieved in 10 patients. Most children had a favorable outcome, with only five pa­tients presenting cirrhosis. Two children died due to com­pli­ca­tions of autoimmune cirrhosis. Conclusions. The out­come of chil­dren with AIH treated with immediate im­mu­no­sup­pres­sive therapy is favorable, with good long-term survival rates and with a positive effect on the quality of life.

S3415 Outcomes of Autoimmune Hepatitis in Hospitalized Patients with HIV

S3415 Outcomes of Autoimmune Hepatitis in Hospitalized Patients with HIV

Autoimmune Sclerosing Cholangitis in Children: A Prospective Case-Control Study.

PurposeIn children overlap of autoimmune hepatitis (AIH) and primary sclerosing cholangitis is labelled as autoimmune sclerosing cholangitis (ASC). The only prospective pediatric study showed a high prevalence of ASC by using endoscopic retrograde cholangiopancreatography. Aims of our study were to find the prevalence of ASC by using magnetic resonance cholangiography (MRC) in AIH and in non-AIH cirrhosis and to compare clinical presentation and outcome of AIH and ASC.MethodsProspectively we did MRC in 38 children with AIH (cases) and 19 disease controls (Wilson disease). Multiple biliary strictures with proximal dilatation on MRC were taken as definitive changes of ASC. Detail clinical, laboratory parameters, liver histopathology and treatment outcome were recorded.ResultsThe median age of cases was 11.5 (3–18) years, 22 (57.9%) were girls and 28 (73.7%) were diagnosed as type 1 AIH. MRC was done in 11 children (28.9%) at the time of diagnosis and in 27 (71.1%) after a median follow-up of 2.5 (0.3–10) years. Abnormal MRC changes were seen in 14/38 (36.8%) of AIH and 8/19 (42.1%) of controls. However, definite changes of ASC were present in four (10.5%) children in AIH and none in controls. None of the clinical, laboratory, histological parameters and treatment response were significantly different between ASC and AIH groups.ConclusionThe prevalence of ASC in children with AIH was just 10.5%. We suggest MRC in select group with cholestatic features, inflammatory bowel disease and in those who showed poor response to immunosuppression instead of all children with AIH.

Presence and type of decompensation affects outcomes in autoimmune hepatitis upon treatment with corticosteroids.

Background and AimsDecompensated cirrhosis in autoimmune hepatitis has poor prognosis. Besides liver transplant, treatment for this entity is undefined. We explored the outcomes of autoimmune hepatitis (AIH)‐related decompensated cirrhosis with active disease on treatment with steroids.MethodsIn this retrospective analysis, clinical data, laboratory parameters, and prognostic scores, such as baseline model for end‐stage liver disease (MELD) scores, were compared among patients of AIH with decompensated cirrhosis with mild/no ascites (n = 38), gross ascites (n = 24), and compensated cirrhosis (n = 32) when administered steroids. The primary outcome was transplant‐free survival at 12 months. Biochemical remission rates and other adverse events were also assessed and compared between these groups.ResultsSteroids were initiated at lower doses (25 mg/day‐mild/no ascites, 20 mg/day‐gross ascites) in patients with decompensated cirrhosis and at 40 mg/day in those with compensated cirrhosis. Transplant‐free survival was 25.4%, 74.6%, and 96.9% (P = 0.001), and biochemical remission occurred in 5.1%, 49.0%, and 64.1% (P = 0.001) at 12 months in patients with gross ascites, mild/no ascites, and compensated cirrhosis, respectively. Infections were seen more frequently in decompensated cirrhosis, while other adverse events were comparable. Among decompensated cirrhosis, those with mild/no ascites had better prognostic scores, fewer posttreatment infections, and more frequent biochemical remission than those with gross ascites, achieving rates comparable to compensated cirrhosis. On multivariate analysis, the MELD score (subdistributional hazards ratio [sHR]; 95% confidence interval: 1.153 [1.07–1.24]; P = 0.001) and ascites (sHR: 2.556 [1.565–5.65]; P = 0.020) predicted survival.ConclusionType and severity of decompensation affect outcomes in patients with AIH‐related cirrhosis. Those with mild/no ascites have comparable outcomes to those with compensated cirrhosis upon treatment with low‐dose steroids.

Normalization of serum immunoglobulin G levels is associated with improved transplant-free survival in patients with autoimmune hepatitis

BackgroundThere is limited evidence linking achievement of biochemical response with outcomes in Autoimmune Hepatitis (AIH), and it is unclear whether normalization of serum immunoglobulin G (IgG) levels influences prognosis. AimsWe aimed to investigate factors associated with death or liver transplantation in patients affected by AIH. MethodsWe undertook a retrospective analysis of all AIH patients attending a tertiary liver unit since 1980. Patients not meeting established diagnostic criteria for AIH or with a follow-up shorter than 18 months were excluded. Results107 patients meeting inclusion criteria were included in the study. Mean age at diagnosis was 44 years, 29 patients (27.1%) had cirrhosis at baseline. Median follow-up was 79 months, and 70 patients (79.5%) reached biochemical response. Biochemical response was associated with reduced hazard of liver transplant or death (HR 0.07, 95% CI 0.01–0.46), whereas cirrhosis at diagnosis was an independent predictor of liver transplantation or death (Hazard ratio (HR) 11.8, 95%, confidence interval (CI) 1.18–117.4). Lack of normalization of serum IgG levels was associated with reduced 5-year transplant-free survival (95% in patients normalizing, compared to 86%, p = 0.02). ConclusionNormalization of serum IgG levels alone translates in better transplant-free survival in patients with AIH and should be a treatment target along with transaminases.

Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases.

The objectives of this document are to provide guidance in the diagnosis and management of autoimmune hepatitis (AIH) based on current evidence and expert opinion, and to present guidelines to clinically relevant questions based on systematic reviews of the literature and the quality of evidence (1). This practice guideline/guidance constitutes an update of the guidelines on AIH published in 2010 by the American Association for the Study of Liver Diseases (AASLD) (2). It updates the epidemiology, diagnosis, management, and outcomes of AIH in adults and children.

Characteristics and Outcomes of Autoimmune Hepatitis from a Tertiary Paediatric Centre, Cape Town, South Africa

To describe the clinical characteristics, biochemical and histological features, outcomes and predictors of prognosis of children with autoimmune hepatitis (AIH) from a paediatric centre in South Africa. Thirty-nine children diagnosed with AIH at Red Cross War Memorial Children's Hospital between 2005 and 2015 were included. Relevant patient's data were retrieved from the hospital's medical records and database. Liver biopsy slides were reviewed. Ethical approval was obtained. Data were analysed using SPSS. Females were 29 (74%). Mean age at presentation was 7.27 ± 3.35 years and the mean follow-up was 4.5 ± 2.4 years. Jaundice was present in 97% of patients at presentation. An acute presentation was observed in 26 (67%) even though cirrhosis was detected in 22 (56%). Autoantibody screening was completed in 35 patients, 20 (57%) were AIH-1, 1 (3%) was AIH-2 and 14 (40%) were seronegative AIH. Of the 25 patients who underwent magnetic resonance cholangiography 17 (68%) had associated autoimmune sclerosing cholangitis. The remission rate was 79%. However, 11 children relapsed later. One child required liver transplantation and one demised. Seronegative and seropositive patients have comparable characteristics and outcomes. While a higher alanine transaminase (ALT) level at presentation is a significant predictor of remission, a lower ALT level and cirrhosis are significant risk factors for unfavourable outcome. Overall survival rate was 97%. AIH responds well to therapy with excellent survival. Hence, it should be considered in any child presenting with viral screen negative hepatitis and start therapy timeously to prevent disease progression.

2961 Characteristics and Outcomes of Patients Hospitalized With Autoimmune Hepatitis in the United States: Nationwide Analysis in 2016

INTRODUCTION: Autoimmune hepatitis (AIH) is a rare inflammatory disorder of the liver, and is associated with liver cirrhosis or hepatic failure. There is scarce contemporary data on epidemiology and outcomes of AIH in the United States. We used a large database to describe the epidemiology of AIH in the hospitalized patient in the USA. METHODS: We used the 2016 National Inpatient Sample Database, to identify all hospitalized patients who were discharged with a primary or secondary diagnosis of AIH (ICD10 K75.4) in 2016. We analyzed the demographics, causes of admission, liver transplantation rates, inpatient mortality and hospital charges. RESULTS: A total of 21,850 (SE 534) patients were admitted with AIH (2405, SE 68 with primary diagnosis of AIH). The mean age of the patient cohort was 55.8 (SE 0.4) years, 12755 (58.4%) were Caucasians, 3530 (16.2%) were African Americans and 16815 (76.9%) were females. Primary causes of admission were AIH (2405, 11%), sepsis (1885, 8.6%), liver cirrhosis (910, 4.2%), acute kidney injury (495, 2.3%), and gastrointestinal bleeding (375, 1.7%). Overall, 330 (1.5%) underwent liver transplantation and 825 (3.8%) died during hospitalization. Mean hospitalization charges were $63,444 (SE 2122), and length of stay was 5.74 days (SE 0.11). CONCLUSION: In the NIS database, we described the demographics of patients admitted with a diagnosis of AIH. Hospital admissions for AIH are associated with high cost and mortality. Moreover, liver transplantation is utilized in a small percentage of AIH admissions.

The Contribution of B Cells in Autoimmune Liver Diseases

Autoreactive B cells can promote autoimmunity through antigen presentation to autoreactive T cells, production of autoantibodies, generation of cytokines promoting T cell activation and differentiation, and inhibition of regulatory T cells and B cells. Here, the authors highlight studies pertaining to B cell mechanisms associated with disease pathogenesis and outcomes in autoimmune hepatitis and the immune-mediated cholangiopathies (primary biliary cholangitis, primary sclerosing cholangitis, and biliary atresia). The vast majority of investigations focus on autoantibodies and future research endeavors should include deciphering the role of the B cell in T cell activation (through antigen presentation, cytokine/chemokine production, and inhibition of regulation). Targeting B cell mechanisms in the treatment of autoimmune liver diseases is also highlighted.

Role of age in presentation, response to therapy and outcome of autoimmune hepatitis

BackgroundFew studies with diverging results and a small sample size have compared autoimmune hepatitis (AIH) in the elderly to younger patients.AimTo unbiasedly investigate the role of age in behaviour and treatment outcome of AIH.MethodsAll patients with probable or definite AIH type 1 in four tertiary academic centres were included in this retrospective—and since 2006 prospective—cohort study. Influence of age on presentation, remission and outcome of AIH were investigated.Results359 patients were included. Presence of cirrhosis at AIH diagnosis around 30% was independent of age. ALAT was higher at age 30–60 years on AIH diagnosis, and above age 60 there were less acute onset, less jaundice and more concurrent autoimmune disease. Remission was reached in 80.2%, incomplete remission in 18.7%, only 1.1% (all aged 50–65) was treatment-refractory. Age was not an independent predictor of remission, while cirrhosis was. Above age 45 there was more diabetes, above age 60 more loss of remission. Rate of progression to cirrhosis was 10% in the 10 years after diagnosis and unrelated to age at AIH diagnosis. With onset below age 30, there was more development of decompensated cirrhosis over time. With higher age at AIH diagnosis there was a lower survival free of liver-related death or liver transplantation.ConclusionsAIH presents at all ages. Age influences features at diagnosis, but not response to treatment, while survival without liver-related death or liver transplantation decreases with higher age at diagnosis.

Epigenetic changes and their implications in autoimmune hepatitis.

The genetic risk of autoimmune hepatitis is insufficient to explain the observed risk, and epigenetic changes may explain disparities in disease occurrence in different populations within and between countries. The goal of this review was to examine how epigenetic changes induced by the environment or inherited as a phenotypic trait may affect autoimmune hepatitis and be amenable to therapeutic intervention. Pertinent abstracts were identified in PubMed by multiple search terms. The number of abstracts reviewed was 1689, and the number of full-length articles reviewed exceeded 150. Activation of pro-inflammatory genes in autoimmune disease is associated with hypomethylation of deoxyribonucleic acid and modification of histones within chromatin. Organ-specific microribonucleic acids can silence genes by marking messenger ribonucleic acids for degradation, and they can promote inflammatory activity or immunosuppression. High circulating levels of the microribonucleic acids 21 and 122 have been demonstrated in autoimmune hepatitis, and they may increase production of pro-inflammatory cytokines. Microribonucleic acids are also essential for maintaining regulatory T cells. Drugs, pollutants, infections, diet and ageing can induce inheritable epigenetic changes favouring autoimmunity. Reversal is feasible by manipulating enzymes, transcription factors, gene-silencing molecules and toxic exposures or by administering methyl donors and correcting vitamin D deficiency. Gene targets, site specificity, efficacy and consequences are uncertain. Potentially reversible epigenetic changes may affect the occurrence and outcome of autoimmune hepatitis, and investigations are warranted to determine the nature of these changes, key genomic targets, and feasible interventions and their consequences.

Epidemiology, Clinical Characteristics and Outcomes of Autoimmune Hepatitis in Olmsted County: A Population-Based Study

Epidemiology, Clinical Characteristics and Outcomes of Autoimmune Hepatitis in Olmsted County: A Population-Based Study

Global Disparities and Their Implications in the Occurrence and Outcome of Autoimmune Hepatitis.

Autoimmune hepatitis has a variable occurrence, clinical phenotype, and outcome, and the factors contributing to this variability are uncertain. The goals of this review are to examine the global disparities in the occurrence and outcome of autoimmune hepatitis, suggest bases for these disparities, and encourage investigations that extend beyond single-center experiences. Disparities in the incidence and prevalence of autoimmune hepatitis in different age groups, genders, ethnicities, and geographical regions suggest that factors other than genetic predisposition are involved. Age- and gender-related antigen exposures from the external (infections, toxins, and medications) and internal (intestinal microbiome) environment may affect the incidence of the disease, and the timeliness and nature of treatment may influence its prevalence. The increasing incidence of autoimmune hepatitis in Spain, Denmark, and the Netherlands suggests that a new etiological trigger has been introduced or that the susceptible population has changed. Variations in mortality between Western and Asian-Pacific countries may result from differences in disease detection or management, and variations in gender predilection, peak age of onset, frequency of concurrent immune diseases, and serological profile may reflect gender-biased and age-related antigen exposures and genetic predispositions. Global collaborations, population-based epidemiological studies that identify case clustering, and controlled interview-based surveys are mechanisms by which to understand these disparities and improve management. In conclusion, autoimmune hepatitis has a rising incidence in some countries and variable occurrence, phenotype, and outcome between countries and subgroups within countries. These disparities suggest that unrecognized population-based environmental, infectious, or socioeconomic factors are affecting its character.

Clinical, Serological, Histological Characteristics and Treatment Outcome of Autoimmune Hepatitis in Elderly Indian Population

Clinical, Serological, Histological Characteristics and Treatment Outcome of Autoimmune Hepatitis in Elderly Indian Population

Clinical characteristics and response to therapy of autoimmune hepatitis in an urban Latino population.

We hypothesized that AIH outcomes might be different in our patient population that consists of a large number of Latinos. Literature has suggested that the presentation and outcome of autoimmune hepatitis can be different among different ethnicity and communities. We performed a retrospective chart review of Latino patients with AIH diagnosed between 2002-2012. Complete and partial remissions were defined as normalization of liver enzyme values, or achieving less than twice the upper limit normal (ULN), respectively. A total of 28 patients were identified. 26 (93%) were female. 13 (46%) had an acute presentation, one with type 2 AIH and 3 with ANA seronegative disease. The average pathologic stage (Ishak score) was 3.44±1.67 (range: 0-6). Complete and partial remission was achieved in 20 (71%) and 5 (18%) patients respectively. Ten patients (38%) required maintenance prednisone either alone (2), or in combination with Azathioprine (6) or Mycophenolate Mofetil (2). Remission in the majority of patients, including 14 (50%) who were cirrhotic. Six of 14 (43%) cirrhotic patients were asymptomatic at the time of diagnosis. In an urban Latino population, cirrhosis was the initial presentation of AIH in a significant percentage of patients raising concerns regarding insufficient screening for AIH in this patient population. A large number of patients required continuous prednisone to avoid relapse.

OC-035 The UK Multicentre Audit of Management and Outcome of Autoimmune Hepatitis (AIH). Overall Outcome and Its Associations

Introduction There are limited data on outcome of AIH outside large centres. We have conducted an outcome audit of AIH in 28 UK centres of varying size. We report overall outcome results in this cohort. Methods We attempted to collect all prevalent cases since 2000 and all incident cases since 2007 by searching electronic patient letters, histology databases and hospital coding. Validation was by 1999 IAIHG diagnostic criteria. Information, on diagnosis, initial severity, treatment and outcome was entered into a web-based data collection system. Results There were 1267 patients (80% female, age at diagnosis (median (range) 55 years (8–86)). IAIHG criteria were not met in 79 (6%) but they were still treated as AIH. At diagnosis, cirrhosis (biopsy, varices, ascites or Fibroscan) was present in 317 (25%) patients and decompensation (ascites, oedema, encephalopathy, variceal bleed or MELD score >15) at diagnosis was present in 282 (22%). Follow-up (time from diagnosis to last seen) was 4 (0–14) years. AIH relapse occurred in 371 patients (141 had ≥2 and 57 ≥ 3 relapses). De-novo cirrhosis developed in 78 (6%) patients, decompensation in 42, and hepatocellular cancer in 7. Fifteen patients died of liver disease, 28 had a liver transplant and 31 died of liver-unrelated causes. Five- and 10 year death/transplant rates were, respectively 6.4±0.1% and 10.0±0.1% (all-cause) and 3.6±0.1% and 5.8±0.1% (liver related). Factors associated with death/transplant rate by Cox regression analysis were (a) cirrhosis, and decompensation at diagnosis (p Both all-cause (p-0.05) and liver-related (p = 0.021) death/transplant were lower in patients attending District General Hospitals (DGHs), compared to University Hospitals; these differences persisted in multivariate analysis (p = 0.017 and 0.036), adjusting for the above baseline predictive factors. Conclusion In this multicentre UK AIH Audit, disease outcome is similar to that in patients reported from large single centres. Main determinants are disease severity, age and comorbidity at presentation. Normalisation of serum ALT at specific time points may not be an accurate longer term outcome marker and better ones are needed. Outcome of AIH in UK patients attending DGHs seems at least as good as those attending University hospitals. Disclosure of Interest None Declared