Type 2 hepatitis no different from type 1 in terms of outcome

Liver outcomes do not differ between types 1 and 2 autoimmune hepatitis presenting in childhood, reports a recent study.

In addition, it is possible to withdraw treatment without prior liver histology, while a persistent abnormal prothrombin ratio determines which patients will need a liver transplant in adolescence or early adulthood.

In this study, 117 children with type 1 (n=65) or 2 (n=52) hepatitis, excluding fulminant hepatitis, received treatment with prednisone and azathioprine from 1973 to 2002. Median follow-up was 20 years among those who survived.

The investigators observed normalization of aminotransferases in 93 percent of children and prothrombin ratio in 84 percent, with remission persisting after withdrawal of treatment in 24 percent of the entire population over a median follow-up of 7 years. Eleven out of 24 children achieved sustained treatment-free remission, with 4 to 22 years of follow-up based on durable normalization of aminotransferases without histologic assessment.

Ten patients had gastrointestinal bleeding from varices, while 22 developed extrahepatic autoimmune disorders. Twenty-three patients received a liver transplant at a median age of 21 years.

At 30 years, the chances of overall and native liver survival were 81 percent and 61 percent, respectively. There were no differences for any of the component parts of the outcome between types 1 and 2 hepatitis. Multivariate analysis revealed the association of a persistent abnormal prothrombin ratio with worse probabilities of overall and native liver survival.

“The results allow for a less-strict approach to treatment withdrawal in children, avoiding the risks of a liver biopsy, and they provide a tool to help anticipate the need for liver transplantation before complications occur,” the investigators said.