Recompensation of decompensated autoimmune hepatitis cirrhosis: a multi-center retrospective analysis

Recompensation is well known in patients with alcohol-associated liver disease (ALD) and viral hepatitis. While there is limited data on patients with autoimmune hepatitis (AIH). The primary objective was to assess the rate of recompensation in AIH-related decompensated cirrhosis; the secondary objectives were to determine predictors of recompensation per Baveno VII criteria, re-decompensation, and further decompensation rates. In this multicentre retrospective study from India, we included patients with biopsy-proven AIH-related decompensated cirrhosis from January 2019 to December 2024. Among 127 patients (aged 48.9±12.8 years; women: 72.4%, Child B: 51.2%; Child C: 48.8%), 77.2% (98/127) patients received immunosuppressive therapy, and 64.3% (63/98) had achieved complete biochemical remission. Forty-four of 127 patients (34.6%, 95% CI, 26.4–43.6) achieved recompensation after a median follow-up of 18 months (0.2–94 months). On competing risk regression analysis, Child Pugh score (sHR, 0.832 [95%CI, 0.7-0.979]; P = 0.02) was the only predictor of recompensation. Of the patients who recompensated, 20.4% (9/44) re-decompensated, and 44.4% (4/9) recompensated again. Of the 83 patients who had not recompensated, 9.6% (8/83) experienced further decompensation; of these, 37.5% (3/8) recompensated later. The transplant-free survival rate among recompensated patients was 97.7% (95% CI, 87.9–99.9) compared with 63.8% (95% CI, 52.5–74.1) among those who did not achieve recompensation ( P < 0.001). Twenty-five per cent of patients with AIH-primary biliary cholangitis recompensated, while none with AIH-primary sclerosing cholangitis recompensated. One-third of patients with AIH-related decompensated cirrhosis recompensate and one in five of such patients re-decompensate again.