Impact of gender on the long-term outcome and survival of patients with autoimmune hepatitis ☆

Background/Aims Autoimmune hepatitis (AIH) predominantly affects women. Reasons for this are unclear and few series have assessed long-term outcomes of men with AIH. Methods To evaluate the clinical course and outcomes of 51 men from a total of 238 consecutive patients with definite AIH at a single centre from 1971 to 2005. The primary outcome measure was death or liver transplantation. Results Median age at diagnosis was 39y in men and 49y in women ( p =0.0589). HLA A1, B8 and DR3 allotypes and the HLA A1–B8–DR3 haplotype were more frequently expressed in men (63% vs. 45%, p =0.049; 74% vs. 38%, p p =0.058; and 50% vs. 23%, p =0.003; respectively). There were no significant differences in clinical manifestations at presentation. Over 96% of patients demonstrated a complete initial response to treatment. A greater number of men experienced at least one relapse (71% vs. 55%, p =0.0591). However, women were significantly more likely to die or require liver transplantation (Log rank test p =0.024). Conclusions Men with AIH appear to have a higher relapse rate and younger age of disease onset which may relate to increased prevalence of HLA A1–B8–DR3. Despite this, men have significantly better long-term survival and outcomes than women.