Aminotransferases during treatment predict long-term survival in patients with autoimmune hepatitis type 1: a landmark analysis

Background & Aims Biochemical remission, important treatment goal in autoimmune hepatitis (AIH), has been associated with better long-term survival. The aim of this study was to determine the independent prognostic value of aminotransferases and immunoglobulin G (IgG) during treatment on long-term transplant-free survival in AIH. Methods In a multicenter cohort ALT, AST and IgG were collected at diagnosis, 6, 12, 24 and 36 months after start of therapy and related to long-term outcome using Kaplan-Meier survival and Cox regression analysis with landmark analysis at these time points, excluding patients with follow-up ending before each landmark. Results 301 AIH patients with a median follow-up of 99 months (range: 7-438 months) were included. During follow-up 15 patients required liver transplantation and 33 patients died. Higher AST at 12 months was associated with worse survival (HR 1.86; p Conclusions Low aminotransferases during treatment are associated with a better long-term survival in autoimmune hepatitis. IgG was not associated with survival in first 12 months of treatment. Normalization of aminotransferases should be the treatment goal for autoimmune hepatitis to improve long-term survival.