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Distinctive clinical phenotype and treatment outcome of type 1 autoimmune hepatitis in the elderly
Author(s) -
Czaja Albert J.,
Carpenter Herschel A.
Publication year - 2006
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.21074
Subject(s) - autoimmune hepatitis , phenotype , medicine , outcome (game theory) , immunology , clinical phenotype , hepatitis , biology , genetics , gene , mathematics , mathematical economics
Abstract Autoimmune hepatitis is classically a disease of young women. Our aims were to determine its occurrence, clinical phenotype, and outcome in elderly patients and contrast findings to young adults. Two‐hundred‐and‐five white North American adults with definite type 1 autoimmune hepatitis were grouped according to age at presentation and the groups compared. Forty‐seven patients (23%) were aged ≥60 years (median age, 68 years), and 31 patients (15%) were aged ≤30 years (median age, 25 years). The patients ≥60 years had a higher frequency of cirrhosis at presentation than the patients ≤30 years (33% versus 10%, P = .03). They also had thyroid or rheumatic diseases more commonly (42% vs. 13%, P = .006). HLA DR3 occurred more frequently in the patients ≤30 years than in those ≥60 years (58% vs. 23%, P = .004), and HLA DR4 occurred more often in the patients ≥60 years (47% vs. 13%, P = .003). Patients aged ≥60 years failed corticosteroid treatment less commonly than those aged ≤30 years (5% vs. 24%, P = .03). Autoimmune hepatitis occurred in patients aged 18‐30 years (15%), 31‐39 years (15%), 40‐49 years (21%), 50‐59 years (25%), and ≥60 years (23%). Differences in age distribution, HLA frequencies, and treatment outcome occurred after age ≥40 years. In conclusion , elderly patients have a greater frequency of cirrhosis at presentation and HLA DR4 than patients ≤30 years, and they have a lower occurrence of treatment failure. Transitions in clinical and genetic phenotypes occur after age ≥40 years. Genetic susceptibilities may favor etiologic factors that are age‐related. (H EPATOLOGY 2006;43:532–538.)