Volume 140, Issue 7, Pages 1980-1989 (June 2011) Long-term Outcomes of Patients With Autoimmune Hepatitis Managed at a Nontransplant Center  Barbara Hoeroldt, Elaine McFarlane, Asha Dube, Pandurangan Basumani, Mohammed Karajeh, Michael J. Campbell, Dermot Gleeson  Gastroenterology  Volume 140, Issue 7, Pages 1980-1989 (June 2011) DOI: 10.1053/j.gastro.2011.02.065 Copyright © 2011 AGA Institute Terms and Conditions

Figure 1 Individual outcomes in autoimmune hepatitis. Of the 40 patients dying of extrahepatic disease, 14 had malignancy, 11 had cardiorespiratory diseases, 2 had sepsis, one had amyloidosis, and one had renal failure and intestinal obstruction. Ten patients died of either old age (n = 6 aged 76–85 years) or cause unknown (n = 4). In all 10 of these patients, liver test results were normal before death. Of the 30 patients dying of liver disease, 2 were referred for transplantation but turned down and 28 were not referred for the following reasons: major comorbidity, 10; comorbidity and age older than 70 years, 7; advanced hepatocellular carcinoma, 8; acute decompensation and death, 1; drug toxicity, 1; and reason for nonreferral not clear, 1. The censored patients included 3 patients who developed pure PBC and 12 who were lost to follow-up (10 moved, 2 defaulted). Gastroenterology 2011 140, 1980-1989DOI: (10.1053/j.gastro.2011.02.065) Copyright © 2011 AGA Institute Terms and Conditions

Figure 2 (A) Overall survival from first presentation. The lower plot shows all-cause death or liver transplant, and the upper plot shows liver-related deaths or transplants, with death due to non–liver-related causes censored. Numbers at risk, given below the figure, are identical for both end points, because in analysis of liver-related deaths, patients were censored in the event of a non–liver-related death. (B) Smoothed hazard estimate for all-cause death or liver transplantation. Hazard rate increased after 7 years of follow-up and was significantly lower during the first decade of follow-up compared with the second decade (log-rank χ2 = 7.8, df = 2, P = .02). A similar trend for liver-related death or transplantation was not significant (log-rank χ2 = 1.75). Both all-cause death/transplantation rate (18% vs 42%; P < .001) and liver-related death/transplantation rate (9% vs 27%; P = .013) were lower during decade 1 compared with decade 2 of follow-up. Gastroenterology 2011 140, 1980-1989DOI: (10.1053/j.gastro.2011.02.065) Copyright © 2011 AGA Institute Terms and Conditions

Figure 3 (A) Association of liver-related death or transplantation with presence of decompensation at presentation. (B) Association of liver-related death or transplantation with presence or development of cirrhosis at any stage (at diagnosis, developing subsequently, or time of onset unknown). Patients with no cirrhosis differed significantly from patients with cirrhosis onset of time unknown (χ2 = 12; P = .01) and from the other groups (χ2 = 19–22; P < .001). (C) Association of liver-related death or transplantation with normalization of serum ALT levels in the first 12 months of immunosuppressive treatment. (D) Association of liver-related death or transplantation with relapse rate per decade of follow-up. Survival in those without relapse was not significantly different from those with one or more relapses when the latter group was pooled. However, unexpectedly, survival in those without relapses was lower (P = .004) in patients without relapse than in those with 0.1 to 1.99 relapses per decade. If patients followed up for less than 1 year (n = 15) are excluded, this difference is smaller but remains significant (P = .028). (E) Association of liver-related death or transplantation with percent of follow-up time on azathioprine. Data missing in one patient. (F) Association of liver-related death or transplantation with mean dosage of azathioprine per kilogram body weight over the period while on the drug. Total number of patients in whom body weight available was 220. Gastroenterology 2011 140, 1980-1989DOI: (10.1053/j.gastro.2011.02.065) Copyright © 2011 AGA Institute Terms and Conditions