Management of Autoimmune Hepatitis Related Decompensated Cirrhosis with Immunosuppressive Therapy in a Non-transplant Resource Limited Setting – an Observational Study

Introduction: To study the clinical profile and management strategies of patients having autoimmune hepatitis related decompensated cirrhosis in a non-transplant resource limited setting. Methods: We collected the retrospective data from 2017 to 2020 of patients with autoimmune hepatitis related decompensated cirrhosis admitted at our tertiary care hospital. Patients with autoimmune hepatitis related decompensated cirrhosis were treated with steroids with or without immunomodulators using a predetermined treatment protocol along with the routine standard of care. The survival at the end of one year and the change in MELD score (delta MELD) was calculated. Results: Out of 67 patients with autoimmune liver diseases, 35 patients with autoimmune hepatitis related decompensated cirrhosis were studied. The mean age was 45.40 + 14.5 years. More than half (54.3%) of the patients were females. The most common form of decompensation was ascites (87.1%). The mean CTP score was 9.89 + 1.6 and mean MELD score was 13.98 + 4.5 at the baseline. About two-thirds (65.7%) of the patients were treated with a combination of oral corticosteroids and immunomodulators, 14.2% were treated with oral corticosteroids alone and 20% were not started on any of the immunosuppressants. At the end of one year, resolution of ascites was seen in more than half the patients (57.1%), with five patients succumbing to their illness. The most common cause of death was sepsis. MELD decreased by a mean of 3.72 points from baseline in patients who survived at the end of one year. None of the patients underwent liver transplantation. There was no significant difference in survival (p value=1) and resolution of ascites (p value=0.16) among patients treated with immunosuppressive therapy when compared to patients who did not receive therapy. Conclusion: In a non-transplant resource limited setting, immunosuppressive therapy did not improve survival in patients with decompensated cirrhosis secondary to autoimmune hepatitis.Figure 1.: Kaplan Meier plot showing patient survival at 12 months.