ArticleJHEP reports : innovation in hepatology2025
Isolated IgG elevation in patients with persistently normal transaminases does not affect the outcome of autoimmune hepatitis.
Article in JHEP reports : innovation in hepatology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Recompensation and Further Decompensation After Index Decompensation in Patients with Autoimmune Hepatitis: A Real-World Study.Digestive diseases and sciences · 2026Article
- Reply to 'Biopsy Before Autoimmune Hepatitis Withdrawal: The Estimand Matters'.Liver international : official journal of the International Association for the Study of the Liver · 2026Article
- Isolated IgG elevation in patients with persistently normal transaminases does not affect the outcome of autoimmune hepatitis: or just a little bit?JHEP reports : innovation in hepatology · 2026Article
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Authors and funding
33 authors.
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Abstract
Background & Aims: The goal of treatment for autoimmune hepatitis is to achieve a complete biochemical response, defined as normalization of transaminases and immunoglobulin G (IgG) levels. Recent data suggest that IgG normalization does not significantly affect survival. We evaluated the impact of persistently elevated IgG levels (IgGe) and IgG flares (IgGf) on fibrosis progression and cirrhosis development. Methods: This retrospective multicenter cohort study included 493 patients with autoimmune hepatitis and persistently normal transaminase levels during follow-up. The inverse probability of treatment weighting (IPTW) propensity score method was used to balance the cohorts. Results: Three hundred forty-nine (70.8%) patients had persistently normal IgG (IgGn) levels, 89 (18.1%) had IgGe, and 55 (11.1%) had IgGf during follow-up. After a median follow-up of 6.2 years (IQR 4.1-10.1 years) with normal transaminase levels, median liver stiffness measurement (LSM) values remained stable, with no significant differences between groups. During the follow-up, 24 patients developed cirrhosis. Predictive factors for cirrhosis were age (hazard ratio [HR] 1.10, Conclusions: Persistent or temporary serum IgG elevation in patients with normal transaminase levels did not significantly affect autoimmune hepatitis disease progression, thus challenging the current definition of complete biochemical response. Impact and implications: The body of evidence showing a lesser impact of immunoglobulin G (IgG)values on outcomes in patients with autoimmune hepatitis (AIH) is growing. However, there is still a lack of robust information on the long-term outcomes, especially in patients who achieve persistent transaminase normalization. Persistently elevated IgG or IgG flares in patients with persistently normal transaminases do not seem to affect outcomes in patients with AIH. These results challenge the current definition of complete biochemical response in patients with AIH. Transaminase level normalization appeared to be the best treatment endpoint.
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