Native liver survival higher in youths with type 2 autoimmune hepatitis

Children and adolescents with type 2 autoimmune hepatitis (AIH-2) seem to enjoy higher rates of native liver survival (NLS), reports a new study. Liver biomarkers, disease remission, and the complement 3 (C3) protein all correlate with NLS, too.

Medical records of 819 patients (median age at onset, 108 months; 75.8 percent female) were reviewed for the present study, of whom 10.4 percent had AIH-2 while the remaining 89.6 percent had type 1 AIH (AIH-1). A total of 762 patients survived until the end of the observation, resulting in a rate of 93.0 percent. NLS was 89.9 percent, and 4.6 percent underwent liver transplantation.

Cox regression analysis was then performed to identify potential predictors of outcomes among AIH patients. The model saw that the risk of liver transplantation or death was at least three times higher in those with AIH-1 (hazard ratio [HR], 3.22, 95 percent confidence interval [CI], 1.17–8.87; p=0.024).

Aspartate and alanine aminotransferase concentrations also correlated with NLS, such that for every one-unit increase in either lab parameter, the likelihood of death or liver transplantation dropped by 3 percent (p=0.006) and 1 percent (p=0.046), respectively.

Similarly, patients who had not achieved complete remission saw significantly worse outcomes, such that the risk of death or liver transplantation was at least 11 times greater in these patients (HR, 11.66, 95 percent CI, 7.06–19.24; p<0.001). An abnormal cholangiogram likewise led to worse NLS (HR, 2.84, 95 percent CI, 1.02–7.90; p=0.046).

Notably, normal levels of serum C3 correlated with significantly with better NLS (HR, 3.39, 95 percent CI, 1.24–9.27; p=0.017).

“[T]he findings of decreased serum C3 levels as an important predictor of low NLS emerge as a new biomarker of disease severity,” the researchers said.

“Future prospective studies can be designed to validate these findings and to explore whether C3 or other components of the complement system may be therapeutic targets in AIH,” they added.