Autoimmune hepatitis in children—Impact of cirrhosis at presentation on natural history and long-term outcome

Little is known regarding the natural history of autoimmune hepatitis in children. The aims of this longitudinal cohort study were to determine the long-term prognosis of children with autoimmune hepatitis and to determine the effect of cirrhosis at presentation on survival.MethodsThirty-three children with autoimmune hepatitis who were seen at our institution over a 25-year period were studied retrospectively.ResultsThe median age of diagnosis was 12.9 years (2.7–18.1) with a female predominance of 3:1. Liver biopsies showed cirrhosis in 18 (55%) patients at time of diagnosis. Patients with cirrhosis at baseline had a similar 10-year survival 85% (70–100%) to those without cirrhosis 75% (49–100%) (p = 0.97). The overall survival was significantly lower than the expected in the age- and gender-matched U.S. population (log-rank test; p < 0.001). In Cox regression models, weight loss (p = 0.037), baseline elevated bilirubin (p = 0.028), prolonged International Normalized Ratio (INR) (p = 0.013), and positive LKM-1 antibodies (p = 0.007) were associated with shorter survival.ConclusionAIH in children is associated with a significant shorter survival rate than the expected in the general population. Cirrhosis on initial liver biopsy does not seem to impact long-term survival in children with AIH.