Predictors of recompensation in immunosuppressive therapy for biopsy-proven autoimmune hepatitis patients with decompensated cirrhosis

INTRODUCTION AND OBJECTIVES: The potential for recompensation in treatment-naïve patients with autoimmune hepatitis (AIH) and decompensated cirrhosis, per Baveno VII criteria, remains underexplored. This study aimed to identify the clinical characteristics and prognostic factors associated with recompensation. MATERIALS AND METHODS: We enrolled 81 treatment-naïve patients with biopsy-proven AIH and decompensated cirrhosis (median follow-up 61.8 months). All patients were treatment-naïve at enrollment and had confirmed diagnoses based on liver biopsy. Using Baveno VII criteria, we assessed recompensation. Data on baseline characteristics, treatment response, and long-term outcomes were collected. Predictive factors were analyzed by Cox regression, and baseline cytokine levels (IL-10, IL-17A, TNF-α, IFN-γ) were compared between recompensated and non-recompensated groups. RESULTS: Among all 81 immunosuppressed patients, 28 (34.6 %) achieved recompensation, which was associated with a reduced risk of all-cause mortality (p = 0.044). Multivariate analysis identified higher baseline BMI (kg/m², HR = 1.161, 95 % CI: 1.022-1.326, p = 0.025), elevated ALT (×ULN, HR = 1.168, 95 % CI: 1.216-1.365, p = 0.028), higher ALB level (g/L, HR = 1.388, 95 % CI: 1.195-1.635, p < 0.001), and complete biochemical response (CBR) at 6 months (HR = 1.895, 95 % CI: 1.154-2.312, p = 0.014) as independent predictors of recompensation, while diabetes was a negative predictor (HR = 0.582, 95 % CI: 0.294-0.896, p = 0.004). Additionally, recompensated patients had significantly lower baseline levels of IL-17A, TNF-α, and IFN-γ. CONCLUSIONS: In this longitudinal cohort of biopsy-proven AIH-related decompensated cirrhosis, 34.6 % of patients achieved recompensation with immunosuppressive therapy, which was linked to superior transplant-free survival. Factors favoring recompensation included higher baseline BMI, albumin, and ALT levels, 6-month CBR, and no diabetes. These patients also had significantly lower baseline inflammatory cytokines.