From First Presentation to Transplantation: Risk Factors for Severe Outcome in Pediatric Autoimmune Hepatitis

Area of Science:

• Hepatology
• Pediatric Gastroenterology
• Immunology

Background:

• Autoimmune hepatitis (AIH) is a chronic liver disease characterized by immune-mediated liver injury.
• Liver transplantation is a life-saving treatment for end-stage liver disease due to AIH.
• Identifying predictors of transplant in pediatric AIH is crucial for timely management.

Purpose of the Study:

• To identify potential predictors of liver transplant in children with autoimmune hepatitis at the time of initial presentation.
• To analyze demographic, clinical, biochemical, and histopathological factors associated with transplant need.

Main Methods:

• Retrospective evaluation of pediatric AIH cases diagnosed between 2000 and 2025.
• Exclusion of patients with de novo AIH or incomplete data.
• Comparison of data between transplanted (n=9) and non-transplanted (n=81) cohorts.

Main Results:

• Moderate-to-severe fibrosis and elevated total bilirubin levels were significant predictors of liver transplant.
• Patients requiring transplant were more likely to have higher GGT, INR, and immunoglobulin levels, and lower albumin and platelet counts.
• Autoimmune hepatitis type 2 was not significantly associated with transplant outcome in this cohort.

Conclusions:

• Systematic risk assessment at diagnosis is vital for identifying high-risk pediatric AIH patients.
• Early identification of predictive factors enables closer monitoring, therapy escalation, and timely transplant referral.
• Tailored management strategies based on predictive factors can improve long-term outcomes in pediatric AIH.