BackgroundFew studies with diverging results and a small sample size have compared autoimmune hepatitis (AIH) in the elderly to younger patients.AimTo unbiasedly investigate the role of age in behaviour and treatment outcome of AIH.MethodsAll patients with probable or definite AIH type 1 in four tertiary academic centres were included in this retrospective—and since 2006 prospective—cohort study. Influence of age on presentation, remission and outcome of AIH were investigated.Results359 patients were included. Presence of cirrhosis at AIH diagnosis around 30% was independent of age. ALAT was higher at age 30–60 years on AIH diagnosis, and above age 60 there were less acute onset, less jaundice and more concurrent autoimmune disease. Remission was reached in 80.2%, incomplete remission in 18.7%, only 1.1% (all aged 50–65) was treatment-refractory. Age was not an independent predictor of remission, while cirrhosis was. Above age 45 there was more diabetes, above age 60 more loss of remission. Rate of progression to cirrhosis was 10% in the 10 years after diagnosis and unrelated to age at AIH diagnosis. With onset below age 30, there was more development of decompensated cirrhosis over time. With higher age at AIH diagnosis there was a lower survival free of liver-related death or liver transplantation.ConclusionsAIH presents at all ages. Age influences features at diagnosis, but not response to treatment, while survival without liver-related death or liver transplantation decreases with higher age at diagnosis.

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 alanine aminotransferase, aspartate aminotransferase (AST), and IgG were collected at diagnosis and 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:A total of 301 AIH patients with a median follow-up of 99 (range Q3, 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 (hazard ratio [HR], 1.86; P < .001), while IgG was not associated with survival (HR, 1.30; P ¼ .53). In multivariate analysis AST at 12 months (HR, 2.13; P < .001) was predictive for survival independent of age, AST at diagnosis and cirrhosis. Multivariate analysis for AST yielded similar results at 6 months (HR, 2.61; P ¼ .001), 24

Background: No prognostic score is currently available for long-term survival in autoimmune hepatitis (AIH) patients. Objective:The aim of this study was to develop and validate such a prognostic score for AIH patients at diagnosis. Methods:The prognostic score was developed using uni-& multivariate Cox regression in a 4-center Dutch cohort and validated in an independent 6-center Belgian cohort.Results: In the derivation cohort of 396 patients 19 liver transplantations (LTs) and 51 deaths occurred (median follow-up 118 months; interquartile range 60-202 months). In multivariate analysis age (hazard ratio [HR] 1.045; p < 0.001), non-caucasian ethnicity (HR 1.897; p = 0.045), cirrhosis (HR 3.266; p < 0.001) andThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Background and Aims:A considerable number of autoimmune hepatitis (AIH) patients completely or partially fail on first-line treatment. Several studies on the use of calcineurin inhibitors (CNIs) in the treatment of AIH have been published without focusing on indication. The aim was to assess the efficacy of CNIs in the treatment of adult AIH patients, specifically focusing on indication: first-line intolerant and with first-line insufficient response (failure to achieve or maintain remission), and with second versus third-line treatment. Methods: A literature search included studies on the use of CNIs in adult AIH. Patients with past or present use of CNIs from the Dutch AIH group cohort were added. The primary endpoint was biochemical remission while using CNIs. Secondary endpoints were biochemical response, treatment failure, and adverse effects. Results: Twenty studies from the literature and nine Dutch patients were included describing the use of cyclosporine in 59 and tacrolimus in 219 adult AIH patients. The CNI remission rate was 53% in patients with insufficient response to first-line treatment and 67% in patients intolerant to first-line treatment. CNIs were used as second-line treatment in 73% with a remission rate of 52% and as third-line treatment in 22% with a remission rate of 26%. Cyclosporine was discontinued in 13% and tacrolimus in 11% of patients because of adverse events. Conclusions: CNIs as rescue treatment in adult AIH patients are reasonably effective and safe both with insufficient response or intolerance to previous treatment. Prospective studies are needed.

Background Frailty could be useful for risk stratification in older patients with Inflammatory Bowel Diseases (IBD). However, no prospective evidence is yet available. We aimed to assess how frailty screening associates with hospital admissions and functional and (health related) quality of life (HR)QoL decline. Methods This is a prospective multicenter cohort study. Consecutive IBD patients aged ≥65 years were included at outpatient departments and infusion centers in six hospitals. Clinical disease activity was assessed through Harvey Bradshaw Index (HBI) or partial Mayo Score (pMS) (remission: HBI&lt;5 or pMS&lt;2), biochemical disease activity by C-reactive protein ≥10 mg/L and/or calprotectin ≥250 µg/g. Frailty screening was performed by Geriatric 8 (G8) questionnaire (abnormal: ≤14). At 18 months, data regarding hospital admissions and mortality were retrieved from medical records and, when possible, verified during follow-up visits. Functional status (Katz Index of Independence in Activities of Daily Living (ADL) and Lawton Instrumental Activities of Daily Living (IADL)) and (HR)QoL (short Inflammatory Bowel Disease Questionnaire and EuroQol-5D) were assessed at baseline and follow-up. Hospital admissions were analyzed with Kaplan Meier and Cox regression, functional and (HR)QoL decline with logistic regression. Analyses were corrected for age and biochemical disease activity. Results 405 patients were included, median age 70 (IQR 67–74), 85 (21%) clinical disease activity, 93 (23%) biochemical disease activity and 196 (48%) abnormal G8. Until February 2021, 293 (72%) patients were eligible for follow-up: 255 participated in follow-up visits, 38 patients did not (15 not reachable, 16 not willing, 7 died). 74 all-cause and 33 IBD-related hospital admissions occurred. Abnormal G8 was associated with occurrence of both all-cause (adjusted HR 3.9, 95%CI 1.9–7.8, p&lt;.001, Fig. 1) and IBD-related hospital admissions (adjusted HR 4.1, 95% CI 1.4–12.3, p=0.012, Fig. 2). Seven patients died during follow-up; six had abnormal G8. 19 (37%) out of 51 patients with both active biochemical disease and abnormal G8 were hospitalized compared to 4 (14%) out of 29 patients with active disease and normal G8 (p=.026). Abnormal G8 associated with functional (IADL: aOR 3.0, 95% CI 1.3–6.9, P.009, ADL: aOR 1.6, 95% CI 0.7–3.3, p.241) and QoL decline (EQ5D: aOR 2.4, 95% CI 1.4–4.3, p.002), not with HRQoL (sIBDQ: aOR 1.3, 95% CI 0.8–2.2, p=.336). Conclusion Abnormal frailty screening independently associates with both all-cause and IBD-related hospital admissions and with functional and QoL decline. Therefore, we provide the first prospective evidence for frailty screening as a useful risk stratification tool in IBD.