Predictors of poor treatment response in pediatric autoimmune hepatitis and autoimmune sclerosing cholangitis
DOI:
https://doi.org/10.15574/SP.2025.7(151).4656Keywords:
children, autoimmune hepatitis, autoimmune sclerosing cholangitis, biochemical responseAbstract
Autoimmune hepatitis (AIH) and autoimmune sclerosing cholangitis (ASC) in children require long-term immunosuppressive therapy; however, complete biochemical response is not achieved within 12 months in a proportion of patients, which adversely affects prognosis.
Aim - to identify predictors of treatment non-response at 12 months in children with AIH and ASC in order to optimise monitoring and guide timely treatment adjustment.
Materials and methods. A retrospective analysis included 55 children with AIH/ASC treated in 2018-2024: responders with complete biochemical response (n=34) and non-responders (n=21). Baseline clinical and laboratory data and liver biopsy findings were assessed. Relative risk (RR), odds ratio (OR) and 95% confidence interval (CI) were calculated.
Results. Non-response was associated with ASC (RR=1.73; 95% CI: 1.07-2.82), anaemia (RR=2.78; 95% CI: 1.30-5.92), thrombocytopenia (RR=9.71; 95% CI: 1.26-75.16), splenomegaly (RR=1.71; 95% CI: 1.17-2.50) and inflammatory bowel disease (IBD) (RR=2.63; 95% CI: 1.32-5.26). Histological predictors included cholangitis activity ≥2 (RR=2.65; 95% CI: 1.58-4.44), ductopenia (p<0.01), biliary interface activity (RR=3.51; 95% CI: 1.58-7.81), and ductular epithelial expression of p16 (RR=1.95; 95% CI: 1.15-3.31) and p21 (RR=5.00; 95% CI: 1.62-15.39).
Conclusions. Individual clinical and laboratory indicators, comorbid IBD, and histological features of biliary injury and cellular senescence activation (p16/p21) were associated with treatment non-response at 12 months and may inform intensified monitoring and timely adjustment of therapy.
The study was conducted in accordance with the Declaration of Helsinki. The protocol was approved by the local ethics committee. Written informed consent was obtained from the children’s legal guardians.
The authors declare no conflict of interest.
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