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SLA/LP antibodies, early cirrhosis indicate poor outcomes in autoimmune hepatitis

Antibodies for the soluble liver antigen/liver pancreas antigen and diagnosis of cirrhosis before 18 years of age were found to be major risk factors for poor short- and long-term outcomes in patients with autoimmune hepatitis, including a reduced overall survival, according to study data published in Hepatology.

“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,” Arndt Vogel, MD, Hannover Medical School in Hannover, Germany, said in a press release. “Our study examines the clinical and genetic features of remission, relapse and liver transplant-free survival in autoimmune hepatitis patients.”

Arndt Vogel

Vogel and colleagues conducted DRB1 allele analyses on 264 patients with autoimmune hepatitis (AIH) and 399 patients without AIH treated at Hannover Medical School between 2000 and 2014. Other analyses, including the human leukocyte antigen (HLA) analysis, were also conducted using patient variables and characteristics. Of all the patients, mean age at first diagnosis was 39 years, 75% were female (n = 267) and most had AIH type 1 (68%). The median follow-up was 10 years, with a range from 1 month to 40 years.

The researchers found that patients diagnosed with AIH in childhood were at increased risk for relapse (P = .003) and liver transplant (LT; P = .014). These patients also had a reduced survival rate (P < .001).

Cirrhosis was found among 25% of patients at first diagnosis. Analyses also showed cirrhosis to be a predictor of poor survival (P = .003) and requiring LT (P = .009).

More patients with AIH were positive for DRB1*03:01 phenotype compared with non-AIH patients (47.7% vs. 20.6%; P < .001), as well as DRB1*04:01 phenotype (28.4% vs. 14.8%; P < .001). DRB1*04:01 phenotype was associated with a higher rate of complete remissions and with a lower frequency of cirrhosis and LT (P = .024), according to the research.  

The soluble liver antigen/liver pancreas antigen (SLA/LP) antibodies were associated with lower overall survival rate (P = .037) and LT-free survival rate (P = .021).

“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,” Vogel said. “On the other hand, patients with DRB1*4:01 have a better clinical outcome in the short- and long-term, suggesting that human leukocyte antigen analysis and screening for SLA/LP antibodies should be integrated in the clinical routine for AIH diagnosis.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.